STAMFORD GOLF CLUB

JUNIOR GOLF, INC

 (607) 652-7398 Jim Schouller, PGA

(607) 652-2457 Gordie Faulkner, Executive Director

2011 JUNIOR GOLF APPLICATION

FIRST COME FIRST SERVED ONLY

Maximum is 70 Juniors.  Must be able to commit to 4 clinic times.

JUNIOR GOLFER NAME_________________________________________________

PARENT (GUARDIAN) NAME____________________________________________

ADDRESS______________________________________________________________

CITY, STATE, ZIP_______________________________________________________

TELEPHONE RESIDENCE________________________________________________

OFFICE____________________________________________________

CELL OR EMERGENCY______________________________________

E MAIL ADDRESS_______________________________________________________

DATE OF BIRTH_________________________________________________________

AGE BY JULY 1^st ________________________________________________________

JUNIOR GOLF PROGRAM PARTICIPANT…..YES, NO or NEW_________________

RIGHT OR LEFT HANDED_______________DO YOU OWN CLUBS_____________

SHIRT SIZE: YOUTH (sm,  med,  lg) ADULT (sm,  med,  lg,  xl)  Circle One

FEE $20.00 FOR ENTIRE PROGRAM MUST BE PAID BY APRIL 15, 2011

NO PARTICIPATION WITHOUT PAID FEE.  PLEASE, ADVISE IF YOU HAVE TO PAY AFTER THE DEADLINE.  Make payment to: Stamford Golf Club Jr Golf, Inc.  Send to Gordie Faulkner, 33 Prospect St., Stamford, NY 12167. 

DO NOT LEAVE THIS APPLICATION AT THE GOLF SHOP-PLEASE, SEND IN.                  

THIS APPL IS ALSO FOR THE ELITE 8.  MUST ATTEND MIN 4 CLINICS.