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BIG ISLAND SENIOR GOLF TOURNAMENT <br />Friday, May 3, 2019 <br />Waikoloa Kings' Course <br />Deadline to Register: <br />April 5, 2019 or limited to the first 140 entries. <br />No refunds after April 19, 2019 <br />Make Check Payable to: Pomaikai Senior Club <br />For Office Use: <br />Registration Date: Time: a.m./p.m. <br />Date Payment Received: <br />Cash <br />Recd Staff Init.: <br />Check # <br />TEAM # <br />Individual Registration I am not with a team. I understand I will be placed in a foursome with other individuals. I am a resident of the Island of Hawai'i. <br />Name <br />(Print legibly) <br />Address <br />(Print) <br />Phone <br />Sex <br />55-64 <br />yrs. <br />(X) <br />65-74 <br />yrs. <br />(X) <br />75+ <br />yrs. <br />(X) <br />March <br />Entry Fee <br />$95.00/ <br />person <br />$5.00 R/T <br />Bus due <br />at <br />check-in <br />(X) <br />Signature <br />(Required) <br />F <br />Or <br />M <br />HDCP <br />Index <br />Team Registration Option to form own team. Please submit ONE form per team. All team members are residents of the Island of Hawai'i. <br />Name <br />(Print legibly) <br />Address <br />(Print) <br />Phone <br />Sex <br />55-64 <br />yrs. <br />(X) <br />65-74 <br />yrs. <br />(X) <br />75+ <br />yrs. <br />(X) <br />March <br />Entry Fee <br />$95.00/ <br />person <br />$5.00 R/T <br />Bus due <br />at <br />check-in <br />(X) <br />Signature <br />(Required) <br />F <br />Or <br />M <br />HDCP <br />Index <br />Note: 1) Registrations will be accepted on a first come first served basis. Limited to the first 140 entries. 2) Acceptance of entry form and payment is your confirmation unless <br />informed by Special Programs staff. 3) You will be notified if you are placed on a wait list. 4) Individual entries: Event Committee will have the authority to group individuals. 5) No Golfer <br />Substitution can be made by a team member. All substitutions will be made by the committee and/or from a wait list. 6) Abusive and/or discriminatory gestures, language, action will <br />not be tolerated, and may be grounds for disqualification from the tournament and future participation. 7) No metal spikes. <br />Checks payable to: Pomaikai Senior Club <br />Mail to: Special Programs, 127 Kamana Street, Hilo 96720 <br />For Information call: Elderly Recreation Services <br />Kea'au 966-5801 Hilo 961-8710 Kona 323-4340 <br />Services and opportunities to participate in Elderly Recreation programs are provided to persons 55 years and older without regard to race, color, national origin, sex, disability or religion. The County <br />of Hawaii does not discriminate on the basis or disability in admission or access to, or treatment or employment in its programs or activities. Should you require special needs, please call the Program <br />Director at 961-8710 at least two weeks before the event. County of Hawai'i is an Equal Opportunity Provider and Employer. <br />