37th SOUTHERN JUNIOR CHAMPIONSHIP
ENTRY APPLICATION
  (Please fill out completely):
                      First                                         Last                 
  Name             

  Address     

  City             State Zip    
  
  Email  Address   

                    Day                          Night                         Cell
  Phone            

                           (mm/dd/yyyy)              (As of 6/16/2009)
  Date of Birth        Age         Age Division  

  Upcoming School Grade (8, 9, 10, 11, 12, Coll Freshman) 

  Special Request 

Those players who have GHIN numbers need to enter them into the Special Request Line
Note: An entry fee of $150.00 must be submitted and received by the SGA office before this entry is formally accepted.

You will be sent an email confirmation of your championship registration.
  Credit Card Information
     Note:  Debit cards are acceptable IF they have the Visa logo.

                        
    Card Number - - -    Expiration Date

  

(Enter first and last name exactly as they appear on the credit card.)
First Name:   Last Name:   

(Enter billing address exactly as it appears on the credit card statement.)
Address:         Address 2:  
City:                State:          Zip: