Official State Application
State Tournament
June 18-19, 2014
Bridger Creek Golf Course
Bozeman, MT
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APPLICANT INFORMATION
Player’s Name___________________________________________
Age (Prior 8/8/2014)_____________________________________________________________
Male/Female_____________ Date of Birth____/____/____
Players Email___________________________________________________________________
Average 18 Hole Score or Handicap_________________________________________________
Parent or Guardian’s Name________________________________________________________
Home Address___________________________________________________________________
City________________ State _____ Zip _________ Phone (
)__________________________
AMATEUR STATUS: The participant must be familiar with the USGA Rules of Amateur Status
and I have conformed to these rules in every respect. Participant must understand the
Championship and Qualifying event regulations and agree that this entry is subject to the approval
or rejection at any time by the Big “I” Officials at their discretion. I understand that the use of
alcohol, drugs or misconduct may disqualify me.
ELIGIBILITY: Boys & Girls who have not reached their 19th birthday prior to August 8, 2014. I
understand the Eligibility and Amateur Status regulations as stated above.
Signature of Applicant_____________________________ Date ________________________
APPROVAL AND CONSENT BY PARENT OR GUARDIAN: As a parent or guardian of the
applicant, I hereby certify the facts as stated in the entry form and attest that I am familiar with
his/her plans to participate and that he/she does so with my approval. I further certify in the event
that emergency medical care needs to be administered to the above named applicant, and the below
mentioned person cannot be contacted, the required parental consent may be given by an
authorized member of the Tournament Committee.
I agree that by registering for this Event, I will allow the information that I have provided in this
registration form (excluding financial and disability information) as well as my image or likeness
to be reproduced by IIABA or the sponsoring state association ("Sponsor") in any media,
including, for example, electronic or print form, for use on web sites, or in any other publications,
promotions, or presentations created by the Sponsor, in the Sponsor's sole discretion.
Signature of Parent or Guardian________________________________Date_____________
In the event of an emergency contact:
Name___________________________________________Phone (
)____________________
Name___________________________________________Phone (
)___________________
NUMBER OF PARENTS ATTENDING THE BANQUET ON WEDNESDAY EVENING
(maximum of 2 at no charge: ______________)
Wednesda & Thursday, June 18-19, 2014: Bridger Creek Golf Course, Bozeman, MT
Sponsored By:
The Independent Insurance Agents of Montana in conjunction
with the Montana Young Agents Committee
Open To:
Boys and girls who have not reached their 19th birthday prior to
August 8, 2014.
Entry Fee:
$80.00 per player-includes two rounds of golf; lunch both days;
Tee Prize and banquet on Wednesday evening for competitors
Please make checks payable to IIAM (Independent Insurance
Agents of Montana). Mail entries to First West, Inc. Attn: Bryan
Hall, PO Box 1800, Bozeman, MT 59771
Divisions:
BOYS
GIRLS
Ages 13 and under
Ages 13-15
Ages 16-18
Ages 13 and under
Ages 14-18
 All age groups will play 18 holes each day. National Qualifiers
must play from Tournament Championship Tees.
 Awards for the top three participants in each division
 Lunch provided after the completion of both rounds
 Banquet on Wednesday evening at 5:30. Up to two parents or
chaperones are welcome at no charge. At 6:30 we will have our
Skills Challenge on the driving range and putting green for a
chance to win some prizes.
 Special Room Rate of $89.00 + Tax at Comfort Inn Of Bozeman,
1370 North 7th Ave, Bozeman, MT 59715; 406-587-2322 Call for
reservations.
ALL ENTRIES MUST BE RECEIVED WITH PAYMENT TO THE PO BOX NO
LATER THAN 5:00PM ON JUNE 16, 2014; THE TOURNAMENT
COMMITTEE IS NOT RESPONSIBLE FOR LATE MAIL. ENTRIES WILL
NOT BE ACCEPTED AT BRIDGER CREEK GOLF COURSE.
NATIONAL TOURNAMENT INFORMATION:
The Top 2 Boys Overall and Top 2 Girls Overall will advance to the 46th Trusted Choice Big “I” National
Championship at Pete Dye Club, Bridgeport, West Virginia, August 5-8, 2014.
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