Wild Oak CC
Mitchell, SD
July 30, 2010
Entry Deadline July 23
Professional Entry Application
Name: ____________________________________________
Address: __________________________________________
City: _________________ State: ______
Zip: _________
Phone:_____________
Cell Phone: ________________
Email _______________________
Social Security #: __________________
Entry Fee $185.00
Payment Type: ____Check ____Money Order ____C.C. *
*Credit Card Information (Visa, Mastercard, or American Express):
Name on Account:_____________________
Type of Card:_________________________
Card Account #:_______________________
Expiration Date: __________________
Send entry to:
Chas Hurd
Pro-Am Entry
Wild Oak CC
2500 EAST 1ST AVE
MITCHELL, SD 57301
