74^th New Hampshire Open Championship

JULY 28 & 29, 2009

Atkinson Resort & Country Club – Atkinson, NH

Application for entry - $250 for PROFESSIONAL or $110 for AMATEUR

Enclose entry fee payable to NHGA and send payment to:

New Hampshire Golf Association, P.O. Box 486, Wolfeboro, NH 03894

PLEASE PRINT AND COMPLETE EVERY BLANK

NAME _____________________________________________________________________

ADDRESS ________________________________________PHONE __________________

CITY __________________________________STATE _______ ZIP __________________

CLUB _______________________________________________

EMAIL ADDRESS ___________________________________

PRO ____ SOCIAL SECURITY NUMBER ____________________________

I AM AN NHC/NEPGA MEMBER: _________________________

AMATEUR ____ GHIN NUMBER (NOT HANDICAP INDEX) _________________

_____ I WILL WANT A CART

_____ I DO NOT WANT MY PICTURE ON THE WEB-SITE

I agree to the championship regulations on the pages of the application. I have read and understand the requirements of eligibility and for acceptance of this entry. I agree this entry is subject to approval or rejection at any time by the New Hampshire Golf Association at its discretion. All contestants must abide by the rules of the host club.

Signature of Applicant _______________________________________ Date ________________

FOR PROS ONLY: MAILING ADDRESS IF DIFFERENT FROM ABOVE. PLEASE PRINT.

NAME _____________________________________________

ADDRESS ____________________________________________________

CITY __________________________ STATE _________ ZIP CODE ______________

NH Open