Women's Golf Association of Massachusetts, Inc. William F. Connell Golf House and Museum 300 Arnold Palmer Boulevard, Norton, Massachusetts  02766 Tel: 774-430-9010        Fax:  774-430-9011

                                             2007 Junior Information Form

         Name:___________________________                 Type   Junior

         Address1:      ____________________________          HomePhone:_______________________

         Address2:       ___________________________________________
                                                                                                    CellPhone:_______________________
                City:     __________________________________________

                                                                                                             DOB:______________________
              State:      ___________________

           ZipCode:     ___________________                                                      Ghin:______________________

              Email       ____________________________________________

             Club1:      ____________________________________________              Club2:       ________________________

Father's Name:____________________________________      Mother's Name:_______________________________________

Check any that are applicable:

_____I plan on participating in WGAM Junior Events (No dues required)

_____I wish to become eligible to participate in WGAM women's events.  Enclosed is a dues payment of $25.00

___Please remove my name from the WGAM list

I/We hereby give permission to the Women's Golf Association of Massachussetts to photograph (print junior's name)

______________________________________ in and at WGAM events.

These photographs and identifying captions may be used in conjuction with the WGAM promotions including publications and/or the WGAM Web site.

Parent/Guardian Signature:_____________________________________   Date: ______________

                (The above information is used for WGAM purposes only.  The WGAM does not sell, trade or rent personal information, whether collected electronically or by any other means, to any other organization)

    Please mail this form to WGAM Office, 300 Arnold Palmer Blvd., Norton, MA 02766.