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2016 Lombard Trophy

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Team Confirmation Form<br />

Club Details<br />

To be completed by the Club Manager and the Professional after the Club Qualifying Round has been held and mailed to<br />

The PGA as soon as possible. (BLOCK CAPITALS PLEASE)<br />

Name of Golf Club:<br />

Competing Professional:<br />

Qualifying Amateur Details<br />

Amateur Name: Age: Handicap:<br />

Address:<br />

Postcode:<br />

Tel No:<br />

Email address:<br />

Will represent our Club at the Regional Final at: Golf Club<br />

In the event of a substitution, the runner up in the Club Qualifying Round was<br />

Amateur:<br />

Handicap:<br />

The sponsors <strong>Lombard</strong> would like to contact you from time to time to conduct market research on the tournament. Your personal data will not be shared with<br />

any third parties. Please tick this box to give them permission to contact you for this purpose.<br />

Amateur Entry Fee Payment<br />

No. of entrants: @ £2/€2.70 (min £50/€67.50) = £/€<br />

We hereby confirm all the details are correct and that we enclose full results of the Club Qualifying Round for your records.<br />

Signature of Club Manager:<br />

Signature of Competing Professional:<br />

Signature of Competing Amateur:<br />

Date:<br />

Date:<br />

Date:<br />

Payment Method entry fee (GBP £2/€2.70 per entry, minimum £50/€67.50)<br />

Payment Method (Please tick appropriate box below):<br />

Payment by Credit Card (AMEX not accepted):<br />

A. Payment by Credit Card<br />

Please complete details in the adjacent boxes<br />

B. Payment by Cheque<br />

Please make cheque payable to ‘PGA Ltd’<br />

C. Paid via BlueGolf<br />

Tick this box if you have pail online using BlueGolf<br />

Please email completed entry forms to: entries@pga.org.uk or using<br />

Envelope ‘B’ provided, please return the following to:<br />

The <strong>Lombard</strong> <strong>Trophy</strong> Tournament Office, The Professional Golfers’<br />

Association, Courtyard 5, Coleshill Manor Office Campus, Coleshill,<br />

Birmingham B46 1DL.<br />

Type of card:<br />

Name on card:<br />

Billing Address:<br />

Card No:<br />

Valid from:<br />

Issue No. (Switch only):<br />

Security Code (Last 3 digits):<br />

Expiry Date:<br />

1. Team Confirmation Form 2. Press Publicity Form 3. Club Results Sheet<br />

4. Amateur Entry Fees (Cheque or payment details) 5. Amateur Entry Sheet<br />

For The PGA Use Only<br />

Pro Elig: Fees: Club Elig: Am Elig: BG:

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