Singles Entry Form WESTERN BCA POOL PLAYERS ASSOCIATION
Singles Play begins Tues, Mar. 13, 2012. See event schedule or online 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.
Player Information Chinook Winds Winners Circle Card #
This is my first entry into a singles event at a Western BCA Regional Tournament. I am a Junior: If yes, Birthdate:
Name: Phone: Email:
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
Mens Master Singles 7 $50 $25 $75
MensA Singles 6 $40 $20 $60

MensB Singles

 5 $30 $15 $45
Mens Senior Singles-Birthdate: 5 $35 $15 $50
Mens Novice Singles 4 $15 $10 $25
Womens Master Singles 6 $50 $20 $70
Womens Open Singles 5 $35 $15 $50
Womens Senior Singles-Birthdate: 5 $35 $15 $50
4 $15 $10 $25
Junior = Player 16-20 years old, Senior = Player 55 or older at start of event Fee Paid:

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 fees include 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 February 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 or enteringSenior Singles, my birthdate is filled in. 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.
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. Send form + fee by date specified by the Tournament Registrar.
Signed:________________________________________________________Date:____________