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Division ____________
Betty & Bobby Allison’s Junior Pro Am
Rivercut Golf Course
Thursday, August 6th, 2015
9:00 a.m. Tee Time
$300 per team (four golfers)
$75 per individual player
Team# _______ Player# ________
APPLICATION
(Please PRINT, use black or blue pen only)
Name______________________________________ Birthdate _______-_______-_______
Month Day
Year
Address_____________________________________________
__________________________________________
(Street Address, Apt. #)
(City/State/Zip Code)
Home Telephone # ______________________________
Grade entering Fall ’15
(please circle ONE)
7
8
9
10
11
12 Graduated*
Parent’s/Guardian Name ____________________________________________________________
Parent’s/Guardian Work Place and Telephone# ____________________________________________________________
Information
The Betty & Bobby Allison’s Junior Pro-Am, in conjunction with the PRICE CUTTER CHARITY CHAMPIONSHIP presented by Dr Pepper,
will be held Thursday, August 6th at Rivercut Golf Course with a shotgun start at 9:00 am. Format will be Four Junior Golfers Scramble
score, plus the score of one (1) Professional Golfer.

A dress code of a collared shirt, shorts (no cut-offs), and soft spikes are required.

There will be two (2) competing divisions. Division I represents the junior high level (grades 7, 8, 9), and Division II represents
the senior high level (grades 10, 11, 12*). *If you will graduate in 2015 but have not played in a college match by August
7th, you are eligible to participate. Competition is open for girls and boys.

Players under 16 will require a parent or guardian to drive the cart. Spectators will not be allowed to use carts.
Registration
Your registration fee includes: participation in the event, logo polo style shirt, logo cap, sleeve of logo golf balls,
and picture with professional golfer. Registration Deadline is August 3, 2015.
Please make your check Payable to: Price Cutter Charity Championship or supply major credit card # and
expiration date.
Price Cutter Charity Championship
3861 East Stan Musial Drive.
Springfield, MO 65809
($300 per Team of 4 OR $75 per individual)
Name of Major Credit Card______________________________________________ Total Amount Charged ___________
Credit Card #_______________________________________________________Exp. Date ________________________
In consideration of my agreement to complete in the Betty & Bobby Allison’s Junior Pro-Am, I, intending to be legally bound, do hereby for
myself, executor and administrators waive, claims for loss, damages or injury to any person or property arising out of my performance or failure
of performance from the Price Cutter Charity Championship, Rivercut Golf Course, the City of Springfield, Web.com Tour, the owner of the
site of any competition or practice I may be participating in, their agents, representatives, successors and assigns. I also agree to abide by
the Web.com Tour Tournament Regulations currently in effect and by the Rules of Golf of the USGA, subject to any modifications thereof
approved by PGA TOUR.
Signature ________________________________________________ Parent Signature __________________________________________________
If you know other participating Junior golfers you wish to team with in your division, please list:
_______________________________
___________________________________
_________________________________