I wish to enter the 2010 Select your event Senior 50 - 59 Super Senior 60 - 69 Grand Senior 70 - 79 The Legends 80 & up Championship.

Name               
Birth Date*   
*Age on Apr 5 (Sr.) or Apr 6 (S.Sr. & G.Sr.) or Apr 7 (Leg.), 2010
No. & Street    Apt No.    
City, St, Zip     
Your Club        Hdcp index
Phone No.    Email

Enclosed is:
$180 for the Senior (age 50-59),
$130 for the Super Senior (age 60-69) or Grand Senior (age 70-79)
$65 for The Legends (age 80 & up)

(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 thru 79;
The Legends 80 & 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: 904-278-0200
Entries close Friday, April 2, 2010