Mixed SCOTCH DOUBLES Entry Form
WESTERN BCA POOL PLAYERS ASSOCIATION
13th Annual Regional 9-Ball Championships
Scotch Play begins: Tuesday, October 12, 2010, 9am. See event schedule or online brackets for each divisions start time. All times and matches online are subject to change without notice.
Chinook Winds Winners Circle Card Numbers M F
Male Player Female Player Division Race Entry Fee Green Fee Total Fee Fee Paid
Name: 6 $100 $20 $120

Phone:
Email: Open 5 $70 $15 $85
I am a Junior Yes No
If yes, Birthdate:  
By entering your Chinook Winds Winners Circle Card number(s) on this form you are automatically entered into a drawing for cash prizes of $250, $150 and $100 sponsored by Chinook Winds Casino Resort. You can only be entered into this drawing by including your winners circle number on an official entry form. One entry per person (not per event entered) will be submitted for this drawing.
Only 1 Grandmaster per team in Master Division.
Green fee covers table time for Scotch Doubles play, 2nd chance tournaments, mini-tournaments, ring games and practice.
Entries must be submitted through your League Operator. Make checks payable to Western BCA. All fees must accompany this form. Your cancelled check is your receipt. Entries must be postmarked or in the hands of your League Operator no later than September 7, 2010. Late entries must be postmarked by September 14 and include
non-refundable late fees of $10 per person. No exceptions. Service charge for returned checks: $25.00.
By signing below, we, the above named entrants, stipulate that we are Western BCA players in good standing, have paid our membership fees for the current year, have met the eligibility requirements for entry into this tournament and are entering in our proper division. If I am a junior, my birthdate is filled in. Our signatures further indicate our agreement that our names and likenesses may be reproduced for publication on the Western BCA website and in any media outlet with which Western BCA contracts for informational and promotional purposes. False information will result in immediate expulsion from the tournament and forfeiture of all fees.
Signed: _________________________&_____________________________Date: ___________

League Operator(s): Review and verify entrants' information and eligibility. Must be signed. Signature below by anyone other than the entrants' League Operator will invalidate this entry. Send form and fee by date specified by the Tournament Registrar.
Signed:___________________________________________________Date:____________