2011 Governor's Open entry form

2011 Governor's Open * September 9, 10, &11

Name:______________________________________
Address: ____________________________________
City________________________________________
State, & Zip: _________________________________
Phone (day):_________________________________
Phone (evening): ______________________________
E-mail add: __________________________________
Home Course: ________________________________
GHIN # __________________
Payment Type  Cash  Check  Visa  MasterCard
Card number: _________________________________
Exp. Date____________________________________
Cardholder's Name: ____________________________
Cardholder's Signature: __________________________
Tax ID or Social Security Number: _________________
OFFICIAL USE ONLY:  Entry #: _____ Check # ____ Amount: ________ Date: __________


Amateur   Professional
All Events  Pro Am Only Open Only
Pro-Am Preference  AM  PM
Flexible?    Yes   No
Senior Pro Division (50+)?  Yes   No
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Mail entry form and fees to:
Juniper Hill Golf Association
P.O. Box 4232
Frankfort, KY 40604-4232
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Please do not mail cash.

Entry deadline: Tuesday, September 6, 12:00 pm (must be received by deadline, not by post mark, if mailed. We can not be responsible for postal service handling.)

Professional entry fee for Open and Pro-Am: $300.00
Professional entry fee for Open only: $250.00
Professional entry fee for Pro-Am only: $110.00
Amateur entry fee for Open and Pro-Am: $190.00;
Amateur entry fee for Open only: $140.00;
Amateur entry fee for Pro-Am only: $75.00;