University of Wyoming First Tee Pro-Am

Jacoby Golf Course

3501 Willet Drive

Laramie, WY

307-745-3111

August 28-29, 2009

Entry Application

Name: _________________________________________
Address: _______________________________________
City: ____________________________State: _________
Zip: ______________
Phone: ______________Cell Phone: __________________
Social Security# (Professionals Only):__________________
Email Address:___________________________________

Circle What Applies:                 Amateur           Professional

       Entry Fee:

Professionals ...........................................$250.00

Amateurs ………….……………………$75.00
Payment Type: Check ____ Credit Card____
**Credit Card Information- We accept Visa & Mastercard:
Name on Account: _______________________________
Type of Card: ___________________________________
Card Account #:__________________________________
Expiration Date: _________________________________
Signature: ______________________________________

Mail To:

Jacoby Golf Course

Attn: University of Wyoming First Tee Pro-Am

Division of Physical Plant, Department 3227

1000 E University Blvd.

Laramie, Wy. 82070