Player Verification Form (Sea Island) Question Title * 1. Player Information Player Name Golf Course Name Current City Current State Abbreviation Birthdate (MM/DD/YYYY) Mobile Phone Question Title * 2. Golf Course Type Public Municipal Private Resort Question Title * 3. Personal Address (used for player gifting) Question Title * 4. Golf Course Address (some gifting sent to golf course directly) Question Title * 5. Indicate the Club Championship division you won at your club Women's Senior Women's Super Senior Women's 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) Women's (~6,000 yards playing distance) Senior Women's (50+ ages ~5,500 yards playing distance) Champion Women's (60+ ages ~5,100 yards playing distance) Question Title * 7. Select your polo size XS S M L XL XXL Question Title * 8. 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 * 9. Does your PGA Professional help you with lessons or coaching? Yes No Question Title * 10. What is your current handicap index? (handicaps are used for entry requirements - all competition is gross with no handicaps) Question Title * 11. 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 without a caddie (no extra fee) Question Title * 12. 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! Question Title * 13. Do you have any medical or allergenic concerns you would like to inform the tournament committee about? Question Title * 14. Please enter your Instagram handle (optional) if you would like to be featured as a Club Champion on our @golfclubchamp account Question Title * 15. Emergency Contact Information during the event Name: Relationship to player: Phone Number: Email: Question Title * 16. I certify that I won a 2022 Club Championship at my club (or past club championship if Covid cancelled the 2022 championship). I understand that falsifying information will result in a 3 year ban from the PGA National Club Championship I acknowledge Question Title * 17. 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 Done