River Cup Qualifier Entry Form
Please fill out the form to enter the River Cup Foundation Qualifier into the D.A. Points Junior Championship sponsored by Pekin Insurance/ Unity Point Health.

Qualifier Info:
Lick Creek GC
June 13, 2018
Tee Times Starting at 7:30am

Entries must be submitted by May 31, 2018
Cost: $75

Pay your entry via PayPal (convenience fee will apply): paypal.me/rivercup/77.02

Please make checks to:
River Cup Foundation
c/o Clifton Larson Allen
Attn- Rusty Gibson
301 S.W. Adams Street, Suite 1000, Peoria, IL 61602

Please read the guidelines and disclaimers for this event before submitting your entry.

IMPORTANT: This qualifier is for 2 exempt spots into the D.A. Points Junior Championship. Successful qualifiers must both pay the entry fee ($295) into the tournament and membership fee ($215) of the AJGA.

River Cup Terms, Agreements, and Waivers can be found at http://rivercup.com/AJGA-documents/

Email address *
Player First Name *
Your answer
Player Last Name *
Your answer
Player Date of Birth *
MM
/
DD
/
YYYY
Contact Phone *
Your answer
Junior Golf Scoreboard Ranking (0 for no rank) *
Your answer
CDGA or USGA Handicap or best guess *
Your answer
Please Check the box and sign below to agree to River Cup Terms and Agreements
Terms, Agreements, and Waivers can be found at http://rivercup.com/AJGA-documents/
River Cup Policies *
Required
Online Signature (Name of parent, guardian, and/or 18 years of age): *
Your answer
Payment *
A copy of your responses will be emailed to the address you provided.
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