To register, fill in the form below and mail check in the amount of $100 (SPECIAL $90 if registered before 12/31/14) to:

121 Presidents Dr.
Amherst, MA, 01003

Please send payment within 14 days of registration. Make checks payable to UMASSM

If you have any additional questions feel free to contact the tournament committee at or our academic advisor, Dr. Tony Lachowetz,


Phone Number






Date of Birth

Graduation Year

Avg. Score


Golf Course Affiliation


Player Email


Parent/Guardian E-Mail

Emergency Contact Number

How Did You Hear About Us?

If Other, Please Specify Below

Please print the waiver below, sign, and mail with payment

I  agree to abide by any regulations of this tournament, including the Code of Conduct.

Player’s Signature________________________________________Date___________

I, for myself and the player, hereby release the host facility, the Western Massachusetts Junior Golf Classic, its sponsors, officers, directors and employees, from any and all liability for any event or consequence whatsoever, in any way arising out of or relating to participation in this event. In case of emergency during this tournament, I authorize a qualified medical doctor to take all necessary measures in the treatment of this tournament participant.  I understand that if a refund is requested the tournament will refund 80% of the tournament fee.  I understand that if inclement weather becomes a factor a full 18 holes will be considered an official tournament.

Parent’s Signature________________________________________Date___________

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