New Mexico-West Texas Qualifying Tournament for the

Official Pre-Qualifying Tournament for
the Optimist East Missouri District
Qualifying Tourament ENTRY FORM
TOURNAMENT INFORMATION
Check-in begins at 7:00 a.m. Proof of age required. Tee times will be
announced at 7:45 a.m. Playing of 9 or 18 holes will be determined by
participation. Rolla Optimist Message Line for weather is 573-426-2211.
District:
Pre-Qualifier, East Missouri
Tournament Date:
May 27, 2015
Location:
Oak Meadow Country Club, 10700 County Road 3110, Rolla, MO 65401
Divisions Offered:
Boys 10-11, Boys 12-13, Boys 14-15, Boys 16-18, Girls 10-12, Girls 13-14, Girls 15-18
Entry Fee:
No Fee. Participants are responsible for providing their own equipment including clubs and golf balls.
Registration Deadline:
Registrations must be received by May 21, 2015
Contact Person:
Optimist Robert Barth -- rollaoptimistgolf@gmail.com -- 573-465-0019 cell
Pre-qualifying requirements: None
Notes:
Push/pull carts and distance measuring devices are permitted in all age divisions.
Qualifying Information:
This is a Pre-Qualifying Tournament for the East Missouri District Qualifyng Tournament for the Optimist International Junior Golf
Championships. The Pre-Qualifying Tournament is sponsored by the Optimist Club of Rolla. No entry fee is required but registrations must be
received by May 21, 2015. Registration includes green fees, lunch, t-shirt, and golf instructional clinic following the awards ceremony. The
Optimist Club of Rolla will pay the entry fee for the boy and girl winners for each age division at the East Missouri District Qualifying Tournament
to be held on June 4, 2015, at Aberdeen Golf Club in St. Louis.
Age Eligibility Information:
Specific age divisions are located at www.optimist.org/golf-championships-divisions.cfm. Specific criteria for 18 year old golfers
apply. See link.
cut and return this section
GOLFER INFORMATION (PLEASE TYPE OR PRINT LEGIBLY)
Golfer’s name:
Birthdate (cannot turn 19 on or before 7/31/2015):
Address:
City, State, Zip:
Parent(s) Name(s):
Home Phone:
Parent Work/Cell Phone:
E-mail:
Division Applying For—determined by golfer’s age on July 20, 2015 (for Boys 10-11, 12-13 and Girls 10-12), July 25, 2015 (for Boys 14-15 and
Girls 13-14 divisions) and July 31, 2015 (for Boys 16-18 and Girls 15-18).
Circle one:
Boys 10-11
Boys 12-13
Boys 14-15
Boys 16-18
Girls 10-12
Girls 13-14
Girls 15-18
WAIVER STATEMENTS
I certify that I am an amateur player according to the rules of the USGA and that all of the information furnished is true to the best of my knowledge.
Golfer’s Signature:
Date:
In consideration of my child’s participation in the Optimist Junior Golf pre-qualifying tournament, I hereby release the sponsor from any and all
liability resulting from any accidents that might occur while he/she is participating.
Parent’s Signature:
Date:
RETURN INFORMATION
Registration deadline is May 21, 2015. Please complete this form in its entirety. Registrations must be received by this date. Return to:
Robert Barth, Jr Golf Chair
Rolla Optimist Club
P.O. Box 1366
Rolla, MO 65402-1366