Scotch Doubles
Entry Form		 WESTERN BCA POOL PLAYERS ASSOCIATION
Scotch Doubles Play begins Mon, March 12, 2012. See event schedule or onlilne brackets for each division's start time. All times/matches online are subject to change without notice. 17th Annual Regional 8-Ball Championships
March 12-18, 2012
Chinook Winds Casino Resort - Lincoln City, Oregon
If possible, please fill out this form before printing. If you cannot please print clearly. Incomplete, inaccurate or illegible forms will delay processing and may be returned.
Male Player Information
Name: Phone: Email:
I am a Junior (16-20 years old): If yes, Birthdate: CW Winners Circle Card #
Female Player Information
Name: Phone: Email:
I am a Junior (16-20 years old): If yes, Birthdate: CW Winners Circle Card #
DRESS CODE EXEMPTION I have a medical excuse exempting me from following the Dress Code
(exemptions will not be granted after entry deadline) If yes, my physician's note is enclosed or it is already on file
Entry Information
Division Race Entry Fee Green Fee Total Fee
Master Mixed Scotch Doubles 6 $100 $20 $120
Open Mixed Scotch Doubles 5 $70 $20 $90

By entering your Chinook Winds Winners Circle Card number(s) on this form you MAY be 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.

Green fee includes table time for this tournament event, 2nd chance tournaments, ring games, mini-tournaments 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 February 6, 2012. Late entries must be postmarked by March 13 and include non-refundable late fee of $10. No exceptions. Service charge for returned checks: $25.00.

By signing below, I, the above named entrant, stipulate that I am a Western BCA player in good standing, have paid my membership fees for the current year, have met the eligibility requirements for entry into this tournament and am entering in my proper division. If I am a junior, my birthdate is filled in. If we are entering the Master Division, do not play under the same League Operator and it is not possible for both of us to sign this form, it is understood that the entrant signing below is signing for both players and stipulates the the information is complete and accurate. My signature further indicates my agreement that my name and likeness 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 and winnings.

Signed:_____________________________________&______________________________________Date: ____________

League Operator: Review and verify entrant's information and eligibility. Must be signed. Signature below by anyone other than the entrant's League Operator will invalidate this entry. If the players named above do not play for the same League Operator, it is understood that the League Operator signing below is signing for both players and verifies that both players meet eligibility requirements. Send form + fee by date specified by the Tournament Registrar.
Signed:________________________________________________________Date:____________