NAME:____________________________________________

ADDRESS:_________________________________________

CITY:____________________________________________

STATE:___________________________________________

ZIP CODE:________________________________________

Base Pass? Y___  N___ *It will be necessary to
obtain a golf pass from SAFB for base entry.
If you are not able to get a pass please add your
driver’s license and date of birth to this form.

Age as of June 1st, 2010:________________________

PARENT NAME:_____________________________________

Date of Birth:____________

Driver’s License #:________________

PHONE:___________________________________________

CELL PHONE:______________________________________

E-MAIL:__________________________________________

I, the undersigned, do hereby release the Texoma
Junior Golf Association, it's directors, officers,
volunteers, as well as the hosting courses, and
officials from any and all liability, accidents,
or injuries sustained by the applicant or parent/
guardian in connection with Texoma Junior Golf
Association. 

Annual Dues and Tour Entry Fees are $140.00.

Signature:_______________________________________ 

Please Print, fill out, and sign this form and
return it to:

Make Checks Payable to: TJGA
PO BOX 246
Burkburnett, Texas 76354