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Player Verification Form (Palm Springs)
1.
Player Information
Player Name
Golf Course Name
Current City
Current State Abbreviation
Birthdate (MM/DD/YYYY)
Mobile Phone
*
2.
Golf Course Type
(Required.)
Public
Municipal
Private
Resort
*
3.
Golf Course Address (used for player gifting so please double check)
(Required.)
*
4.
Personal Address (used for player gifting)
(Required.)
*
5.
Indicate the Club Championship division you won at your club
(Required.)
Men's
Senior Men's
Women's
Senior Women's
*
6.
Indicate the division you will be competing in for the PGA National Club Championship (this is the package you paid for when signing up)
(Required.)
Men's
Senior Men's (50-59 division)
Champion Men's (60+ division)
Women's
Senior Women's (50-59 division)
Champion Women's (60+ division)
7.
Which PGA Golf Professional do you work most closely with at your course? (e.g. Bill Harrison, PGA). *All competitors must be at a facility with a PGA Professional*
*
8.
Does your PGA Professional help you with lessons or coaching?
(Required.)
Yes
No
*
9.
What is your current handicap index? (handicaps are used for entry requirements - all competition is gross with no handicaps)
(Required.)
*
10.
You will have the option to walk or ride for the 3 competition rounds. Please indicate your preference:
(Required.)
I plan to bring my own caddie and walk
I plan to bring my own caddie and ride
I plan to walk
I plan to ride (no extra fee)
11.
Do you have any cool stories from your Club Championship victory? We will be putting together stories to share with press and media. Please provide a brief summary!
12.
Do you have any medical or allergenic concerns you would like to inform the tournament committee about?
13.
Please enter your Instagram handle (optional) if you would like to be featured as a Club Champion on our @golfclubchamp account
14.
Emergency Contact Information during the event
Name:
Relationship to player:
Phone Number:
Email:
*
15.
I certify that I won a 2021 Club Championship at my club (or past club championship if Covid cancelled the 2021 championship). I understand that falsifying information will result in a 3 year ban from the PGA National Club Championship
(Required.)
I acknowledge
*
16.
By checking "I Agree" I hereby acknowledge that I have received, had an opportunity to review, and agree to all of the linked
terms and conditions
of entry, release and waiver of liability
(Required.)
I Agree
