Participant's 2017 Entry Form
Submit your entry and payment by midnight September 1st, 2017 and we will deduct $50.00 from your entry fee.
Note: Deadline for entry fees is November 1st, 2017 and are on a first come, first served basis. Participants will not be
confirmed until entry form and full payment is received.
First Name   Last Name
City State Zip Code
Telephone Fax
Email Address
Age Index (proof required)
Maximum handicap 14.0. Field limited to 111 participants.
Pullover Size
Belt Size (belt size is 2 sizes larger than your pant waist size)
Category (Please click appropriate options)
Professional ($675)
Amateur ($550)

Senior (55+)

Will you be joining us on Monday 27 November for the optional 4 Ball Match Play Pro Am (12:00pm Shotgun at Port Royal GC) followed by the Goslings 2017 Invitational Welcome Party? YesNo
If you have any questions regarding the 2017 Championship please contact Championship Director Robby Thompson ( or Championship Administrator Karen Marsh (
Payment (please supply credit card details)

Name as it appears on the card
Card number
Security code (from back of card)
Zip Code (on card account)

Expiration /

 Support Ref: 1006297845