Print, complete and return this form, along with a check for your entry fee ($40 per person or $160 per team).  Assemble your own foursome or be placed with a team. Register one team on a single form. Mail completed form and entry fee to:  PMABA, PO Box 1392, Pinnacle, NC  27041-1392.  Call Darin Young at 336-972-4960 to reserve your space.


Player #1 Name: ________________________________________________________________________________________________

                E-mail: ________________________________________________________________________________________________

                Phone: (H): _______________________________________________     (Cell): _____________________________________



Player #2 Name: ________________________________________________________________________________________________

                E-mail: ________________________________________________________________________________________________

                Phone: (H): _______________________________________________     (Cell): _____________________________________



Player #3 Name: ________________________________________________________________________________________________

                E-mail: ________________________________________________________________________________________________

                Phone: (H): _______________________________________________     (Cell): _____________________________________



Player #4 Name: ________________________________________________________________________________________________

                E-mail: ________________________________________________________________________________________________

                Phone: (H): _______________________________________________     (Cell): _____________________________________



TOTAL AMOUNT ENCLOSED: $ __________________