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Keystone State Games, Inc.
PSG / KSG Golf
Athlete's Last Name:
Athlete's First Name:
Athlete's Date of Birth:
month/day/year: Example 12/31/2016
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Open Division: 18 - 29 years of age
Open Division: 30 - 39 years of age
Open Division: 40 - 49 years of age
Youth Division: 8-12 years of age
Junior Division: 13 - 15 years of age
Scholastic Division: 16 - 17 years of age
Age Division: Senior Games
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
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NATIONAL QUALIFYING SPORT Minimum Performance
Standards qualify for NSG
EVENTS - Individual Female & Male Competition
SITE - Wyoming Valley Country Club, 1695 Main Street, Wilkes-Barre, PA 18703
· An 18-hole one day competition.
· Shot Gun Start will begin at 8:00am.
· The low gross scoring system will be used.
· USGA rules will apply.
· Participants must bring their own equipment.
: $25.00 + green fees
KSG RELEASE WAIVER
PSG MEDICAL RELEASE FORM
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