Player Verification Form (Palm Springs)

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* 1. Player Information

Player Name

Golf Course Name

Current City

Current State Abbreviation

Birthdate (MM/DD/YYYY)

Mobile Phone

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* 2. Golf Course Type

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* 3. Golf Course Address (used for player gifting so please double check)

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* 4. Personal Address (used for player gifting)

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* 5. Indicate the Club Championship division you won at your club

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* 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)

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* 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

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* 8. Does your PGA Professional help you with lessons or coaching?

Yes

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* 9. What is your current handicap index? (handicaps are used for entry requirements - all competition is gross with no handicaps)

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* 10. You will have the option to walk or ride for the 3 competition rounds. Please indicate your preference:

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)

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* 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!

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* 12. Do you have any medical or allergenic concerns you would like to inform the tournament committee about?

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* 13. Please enter your Instagram handle (optional) if you would like to be featured as a Club Champion on our @golfclubchamp account

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* 14. Emergency Contact Information during the event

Name:

Relationship to player:

Phone Number:

Email:

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* 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

I acknowledge

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* 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

I Agree

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* 1. Player Information

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* 2. Golf Course Type

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* 3. Golf Course Address (used for player gifting so please double check)

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* 4. Personal Address (used for player gifting)

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* 5. Indicate the Club Championship division you won at your club

Question Title

* 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)

Question Title

* 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*

Question Title

* 8. Does your PGA Professional help you with lessons or coaching?

Question Title

* 9. What is your current handicap index? (handicaps are used for entry requirements - all competition is gross with no handicaps)

Question Title

* 10. You will have the option to walk or ride for the 3 competition rounds. Please indicate your preference:

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* 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!

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* 12. Do you have any medical or allergenic concerns you would like to inform the tournament committee about?

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* 13. Please enter your Instagram handle (optional) if you would like to be featured as a Club Champion on our @golfclubchamp account

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* 14. Emergency Contact Information during the event

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* 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

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* 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

* 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