Entry Form - Indonesian Open

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 )