Entry Form

Charles Blair Macdonald Challenge and
Eastern Canadian Hickory Championship

NAME: ___________________________________________________________________________

ADRESS: _________________________________________________________________________

E-MAIL: __________________________________________________________________________

Please indicate the division entered (Check one):
__ OPEN CHAMPIONSHIP (18 holes each day — Friday, Saturday and Sunday)
__ SENIOR CHAMPIONSHIP (18 holes each day — Friday, Saturday and Sunday)
__ SUPER SENIOR CHAMPIONSHIP (18 holes each day — Friday, Saturday and Sunday)
__ OPEN (59 and under) (18 holes each day — Saturday and Sunday)
__ SENIOR (60 to 69) (18 holes each day — Saturday and Sunday)
__ SUPER SENIOR (70 and older) (18 holes each day — Saturday and Sunday)
__ LADIES (18 holes each day — Saturday and Sunday)

HANDICAP: SoHG HICKORY _____ or MODERN (if you have no hickory handicap) ____

COST (includes Friday's round): $285.00 (limited field – entries close May 1, 2017)
EXTRA MEALS for Guest(s): (at $25 per meal)
– for Saturday________________
– for Sunday _________________
RENTAL CLUBS:
– Post 1900 set – $25.00 per set _______________
– Pre-1900 set – $35.00 per set ________________
(Please include payment with entry form)

Send entry with cheque payable to Paul Dietz to:
Paul Dietz
509 Hedden Court
Sarnia, Ontario, Canada
N7S 6L8

Note: participants withdrawing from the event have two options (a) their entry fee minus 15% returned to them OR (b) entire entry fee applied to the following year's event.

Entries not accepted without accompanying entry fee – Cheques may be post-dated to May 1, 2017.

Questions? Please contact Paul Dietz at 519-331-6585 or at clubdoc1@gmail.com

Disclaimer: ALL PARTICIPANTS MUST SIGN: Participant agrees to release, defend and hold harmless The Golf Historical Society of Canada, their tournament committee members, The Niagara-on-the-Lake Golf Club, their agents and employees from and against any and all losses, costs, damages,or expenses (including attorney fees) arising out of or resulting from any accident, bodily injury, property loss, damage, or other occurrences to any person or persons, including the participant, his/her agents, employees and invitees arising out of or resulting from participant use and occupancy of the Niagara-on-the-Lake Golf Club property.

Signature of Participant _________________________________________