I wish to enter the 2009 Select your event Senior 50-59 Super Senior 60-69 Grand Senior 70 & Up Championship.

Name               
Birth Date*   
*Age on Apr 6 (Sr.) or Apr 7 (S. Sr. & G. Sr.), 2009
No. & Street    Apt No.    
City, St, Zip     
Your Club        Hdcp index
Phone No.    Email

Enclosed is:
$175 for the Senior (age 50-59),
$125 for the Super Senior (age 60-69) or Grand Senior (age 70+)

(Make check or money order payable to JAGA).

                                                                          Entry Fee $
Optional contribution to JAGA Scholarship Fund $
                                                                                   Total $

*Age: Senior 50 thru 59;
Super Senior 60 thru 69;
Grand Senior 70 and up.

Verify your entries above then print this form.  Send it and your check to:

Gary Owensby
1611 Spring Water Ct.
Fleming Island, FL 32003

Tel: 904-264-5448
Entries close Wednesday April 1, 2009