4th West Virginia Senior Open Championship Conducted by the West Virginia Association May 11-12, 2016 The Greenbrier Resort (Greenbrier Course), White Sulphur Springs, West Virginia

APPLICATION FOR ENTRY PLEASE REVIEW ELIGIBILITY REQUIREMENTS PRIOR TO COMPLETING ENTRY Entry Fees: Amateurs $175 PGA Member: $250 Non-PGA Member: $300 ENTRY DEADLINE: WEDNESDAY May 4, 2016 WVGA, 2115 Charleston Town Center, Charleston, WV 25389. Late or incomplete entries are NOT accepted NAME: ______EMAIL: ______ADDRESS: ______CITY: ______STATE: _____ ZIP: ______Phone: ______Cell Phone: ______MEMBER CLUB: ______BIRTHDATE: ____/____/_____ Professional or Amateur (circle one) Amateur Only: WVGA/Membership # (GHIN) ______HDCP INDEX: ______Professional Only: PGA Membership # ______Division: (Circle One) Championship/Senior (50-59) Silver (60-69) Gold (70 +) Championship Format: The 4th West Virginia Senior Open Championship will be a 36-Hole event. Each division will play from a different set of , and a Winner will be awarded in each division. The overall Senior Open Champion and the Low Senior Amateur Award will come from the Championship Division. Professionals as well as Amateurs will compete together based upon age/division.

ALL CHAMPIONSHIP INFORMATION MAY BE FOUND ONLINE AT WVGA.ORG WV Golf Association Tournament Policies, including Code of Conduct, Residency, Withdraw/Refunds, Pace of Play Procedures, and Dress Code, can be viewed at wvga.org. Championship Regulations: I understand this application may be accepted or rejected by the West Virginia Golf Association ("WVGA") at any time without cause. I also understand that my participation in WVGA tournaments or events may be suspended or revoked if I am found to have violated the , the LOCAL RULES, the WVGA CODE OF CONDUCT, or the WVGA DRESS CODE POLICY. I further understand that the WVGA is in no way responsible for the action of any or any host in refusing privileges to their facility or the behavior of any said member of WVGA. In consideration of the privilege of participation in WVGA tournaments and events, I hereby release and covenant not to sue any sponsor of the WVGA, any club hosting a WVGA tournament or event, the WVGA, their employees, agents, representatives, directors, shareholders, Executive Committee Members and assigns from any and all liability or damages arising or resulting from any accident, injury or death or from any claim or cause of action based in either contract, tort or statutory law. I agree to strictly observe the rules and etiquette of golf, and properly and courteously conduct myself on the course and in the clubhouse. I understand that the WVGA reserves the right to change its rules, regulations and policies. By signing below, I acknowledge that I have read and fully understand all the rules, regulations and policies of the WVGA. Furthermore, I agree to abide by these rules, regulations and policies at all times. If at any time I fail to comply with the rules, regulations and policies of the WVGA, my participation in current or future events and/or my membership may be suspended or revoked. Also, by signing below, I verify that I am a resident of the state of West Virginia (where required) and that the information provided above is true and correct to the best of my knowledge.

SIGNATURE OF APPLICANT: ______DATE: ______

CREDIT CARD: (Visa/MC) ______-______-______-______Exp. __ __ / __ __ CIV CODE: ______

BILLING ADDRESS: ______CITY: ______STATE:_____ ZIP: ______

Added to my entry fee is an additional $______as a tax-deductable contribution to the WV Golf Foundation.