Boomers Golf.com
PROFESSIONAL GOLF TOUR
458 Leighann Road Henderson, Nevada 89015
Phone: (702) 568-9672 ..... Fax: (702) 568-9657
ENTRY FEE APPLICATION 

Date of event:_______________ Event location:____________________
By signing this application, I agree to conduct myself in a professional manner and be financially responsible for any debts or expenses incurred by me. By execution of this application, I agree to abide by the policies and procedures, code of conduct and all regulations set forth by Boomers Golf.com, as well as any local rules or regulations presented by the hosting golf courses.

By signing this application I acknowledge and assume all risks and save harmless and indemnify Boomers Golf.com, and all of its' owners, employees, agents, independent contractors, sponsors and the hosting golf courses, from and against any and all liability, loss and expense arising directly or indirectly from participating in any tournaments; whether or not such liability, loss or expense occurs by reason of damage to property or injuries to persons, and whether or not any such damage or injury occurs as a result of negligence of Boomers Golf.com, its' owners, employees, agents, independent contractors, sponsors or hosting golf course, or any other party.

Name:__________________________________________ SSN: __________-_______-___________

Address:__________________________________________________________________________

City:_____________________________________State:____________Zip:_____________

Home Phone:(________)_________________Cell Phone:(_______)___________________

E-mail address_________________________________ Fax:(_____)__________________

Emergency Contact :___________________________ Phone:(_____)_________________

Age:__________ DOB:______________

Must be 50 years of age, or older to participate; new applicants enclose copy of birth certificate or drivers license showing proof of age/eligibility.

By signing this application I also agree to release any and all personal or historical information herein for media coverage of play or practice at the event sites or for public relations use, to Boomers Golf.com. Please note that Boomers Golf.com reserves the right to reject any application at their discretion.

___________________________________________________________________________

(Signature) (Date)

I have enclosed the entry fee of __________ with this application. Method of payments currently accepted: Cashiers check, money order or personal check.