Final proof 2017

---

OFFICIAL ENTRY FORM

48th Annual Dubois County Men’s Amateur Golf Tournament 2017 54 Hole Tournament Saturday, July 15

Sunday, July 16

Sunday, July 23

Huntingburg Country Club

Sultan’s Run

Buffalo Trace

Name __________________________________________Age ______ Home Course__________________________ Address ________________________________________City ____________________________________________ Entry Fee: $50 (cart Fee not included) $________________ $30 for graduating high school senior or younger

Voluntary contribution to the First Tee of Indiana South Central (federal tax I.D. #35-2145820) $ ____________ Carts are available for all participants Will you be needing cart ____yes ____no (Pay for carts at local club)

Total Enclosed

$ ____________

make checks payable to Dubois County Amateur ELIGIBILITY: To be eligible for the tournament, a participant must: (1) live in Dubois County or (2) be a member of one of the golf courses in the County (Buffalo Trace, Ruxer Municipal, Huntingburg Country Club, Sultan’s Run) and live in one of the following adjoining counties-Martin, Pike, Warrick, Spencer, Perry, Crawford, Orange or Daviess.

Liability Form

This liability form must be completed by all golfers in order to participate. In consideration of the foregoing, I, my myself, my executors, administrators and assignee, do hereby release and discharge The Herald, the Dubois County Men’s Amateur Golf Tournament Board of Directors, Sultan’s Run, the Huntingburg Country Club, Buffalo Trace and the City of Jasper for all claims of damage, demands, action whatsoever in any manner arising or growing out of my participation in said tournament. I certify that I have prepared for this event and am in adequate physical condition to compete. I agree to follow all rules of the event and to permit myself to be removed from competition if in the opinion of tournament administrators my continuing would endanger my health.

Signature of entrant

________________________________________ (and of parent/guardian if under 18) __________________________________________________________

Date_______________Telephone __________________________

e-mail address ____________________________________

ALL ENTRIES MUST BE MAILED Mail to: Dubois County Amateur, P.O. Box 382, Jasper, IN 47547-0382 ENTRIES MUST BE POSTMARKED NO LATER THAN FRIDAY, JUNE 30, 2017 NO LATE ENTRIES FIELD LIMIT IS 80 Cut after 2nd Round

Golf and Charity - A Great Combination! The opportunity to add the First Tee of South Central Indiana as a primary charity for the Annual Dubois County Amateur Tournament was simply too good of an opportunity to pass up. The “AM” will donate monies each year to the First Tee Program of South Central Indiana. We ask each of the participants to consider a voluntary, tax-deductible contribution as part of your “AM” participation, we believe the ability to play golf - both physically and financially - is a privilege, and in return for such privilege we can assist our youth by helping introduce them to the game of golf and the inherent life lessons and values it teaches.

MORE THAN A SPORTS PROGRAM The first Tee is a international youth development organization introducing the game of golf and its inherent values to young people. Through after school and in school programs, it helps shape the lives of young people from all walks of life by reinforcing values like integrity, respect and perseverance through the game of golf. And it’s making a difference. The research-proven programs are having a positive impact on participants, their families and their communities. All contributions will be used by the 1st Tee South Central Chapter.

BY THE NUMBERS 7.6 Million 14,000 5,300

participants reached since 1997 volunteers actively engaged elementary schools introduced to The First Tee National School Program during the 2012-2013 school year 50 U.S. states offering The First Tee programming 4 4 International location offering The First Tee programming 1st Tee South Central (Dubois, Harrison, Orange and Crawford Counties) Dubois County Contact: 812-767-6170 or 812-639-7813

Indiana