Friday, May 19th 2017

Amelia National Golf Club

95211 Clubhouse Road Fernandina Beach, FL  32034

Presented By:

Tournament Highlights:

Captain’s Choice
Putting Contest
Golf Shirts
Complimentary Beverages
Awards & Raffle Prizes
Breakfast Reception & Lunch

Schedule of Events:

Breakfast/Check-in          8AM
Shotgun Start                   9AM
Lunch & Awards              2PM (or end of play)

Charity Golf Tournament 2017 Registration Form

Company Name:

Player Name

Handicap:

Your Phone Number

Your Email

Your Street Address

Your City

Your State

Your Zip


Participation Level

Please Choose One (Check all that apply.)

Platinum - $2500.00Gold - $1200.00GaurdianSilver - $600.00Individual - $150

Other Opportunities

Corporate Signage - $250.00Family Signage - $50.00Lunch Sponsor - $750.00Lunch & Awards Ceremony for Non-players - $25.00


Players Name / Handicap

The DSAJ will provide all participants with golf shirts at the tournament.Please provide shirt sizes.

1 Players Name:

Handicap:

Shirt Size:
Adult SMAdult MEDAdult LGAdult XLAdult XXL


2 Players Name:

Handicap:

Shirt Size:
Adult SMAdult MEDAdult LGAdult XLAdult XXL


3 Players Name:

Handicap:

Shirt Size:
Adult SMAdult MEDAdult LGAdult XLAdult XXL


4 Players Name:

Handicap:

Shirt Size:
Adult SMAdult MEDAdult LGAdult XLAdult XXL


Payment Method

After submitting your on-line form please select the Pay Now button below to pay the total entry fees on-line.

Participation Levels:

Title Sponsor - $5,000.00

Proudly held by BDO

Individual Player - $150.00

Sign up today! Limited Individual Spots Available

Platinum - $2,500.00

2 foursomes, breakfast, lunch & awards ceremony, one tee box sign, signage on putting green & signage on front and back nine (two), sponsor gift

Gold - $1,200.00

1 foursome, breakfast, lunch & awards ceremony, one tee box sign and sponsor gift

Silver - $600.00

2 individual golfers, breakfast, lunch & awards ceremony, one tee box sign & sponsor gift.

Corporate Hole Signage - $250.00

includes one tee box sign

Family Hole Signage - $50.00

includes one tee box sign

Lunch & Awards Ceremony for Non-Players -$25

$25 per person