ENTRY FORM
INDIVIDUAL
Organizing Committee
The 31st Indonesia Senior Amateur Open 2009
Jl. Cibulan II No. 3 Kebayoran Baru, Jakarta 12170, Indonesia
Phone +62-21-727 92112 Fax +62-21-722 1180
+62-21-727 96056
E-mail : isgs_perpesi@net-zap.com
Dear Sir,
I herewith submit my entry for The 31st Indonesia Senior Amateur Open,
which will be
held on 21 - 22 October 2009.
Name : __________________________________________________
Date of Birth : __________________________________________________
Contact Address : __________________________________________________
__________________________________________________
Phone : HP Fax _____________
My Club Affiliation is : __________________
My current USGA-Handicap Index is __________
My most recent Course Handicap is __________
(this handicap must be approved by Course Handicap Committee)
My T-Shirt size :
□ M ( Body width 52 cm )
□ L ( Body width 54 cm ) □ □ XL ( Body width 56 cm ) □ .....
□ □ XXL ( Body width 58 cm )
My Hand Glove size :
□ 24 □ 25 □ 26 □ ............. □
Enclosed is proof of payment of my registration fee.
Date : _____________________
Signature :
I hereby certify that participants
handicap is correct
Participant Captain/H’cap Committee and stamp of club
Note : If necessary form may be copied
CLOSING DATE FOR ENTRIED
Thursday, October 1st, 2009
(First come first served )
ENTRY FORM
TEAM
Organizing Committee
The 31st Indonesia Senior Amateur Open 2009
Jl. Cibulan II No. 3 Kebayoran Baru, Jakarta 12170, Indonesia
Phone +62-21-727 92112 Fax +62-21-722 1180
+62-21-727 96056
E-mail : isgs_perpesi@net-zap.com
Dear Sir,
I herewith submit my entry for The 31st Indonesia Senior Amateur Open,
which will be held on 21 - 22 October 2009.
Club Name : _________________________________________________________
The Captain Name : ___________________________________________________
Contact Addres : _____________________________________________________
_______
Phone HP Fax __________
TEAM I :
1. H’Cap _______
2. H’Cap _______
3. H’Cap _______
4. H’Cap _______
TEAM II :
1. H’Cap _______
2. H’Cap _______
3. H’Cap _______
4. H’Cap _______
Date : _____________________
Signature :
I hereby certify that participants
handicap is correct
Participant Captain/H’cap Committee and stamp of club
Note : If necessary form may be copied
CLOSING DATE FOR ENTRIED
Thursday, October 1st, 2009
( First come first served )
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