Japan-America Society of Indiana and the
Indiana Japan Chamber
present the

21st Annual Golf Classic

Sunday, September 23, 2012
The Brickyard Crossing Golf Club

4400 West 16th Street, Indianapolis, IN 46222


Players’ names or foursome team: (プレイヤーのお名前)

We would like to play together  (同チームでのプレイを希望)
We would like to play separately  (別チームでのプレイを希望)

Contact Information (ご連絡先)

(in case of cancellation due to weather. 天候に寄るキャンセルのために緊急ご連絡先をお知らせください。)

Registration Fees (per attendee)

JASI & IJC Members $150
Public $170

Payment Method

Mail Check (小切手郵送)
Make check payable to:
Japan-America Society of Indiana, Inc
Union Station, 39 West Jackson Place, Suite 50
Indianapolis, IN 46225
Online Credit Card (オンライン支払い)
If you elect to pay by credit card you will be taken to a form immediately after this form has been successfully submitted.


Help make this year’s tournament the most exciting yet by donating a special prize.
Foursome prizes needed!


My company and / or I will donate the following prize(s)

If you wish to donate quality items for Give-Away Bags, please provide 144 items.