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

*恐れ入りますが、ご記入は全て英語にてお願い申し上げます。

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)

Name 
Title 
Company 
Handicap 


Name 
Title 
Company 
Handicap 




Name 
Title 
Company 
Handicap 



Name 
Title 
Company 
Handicap 

Contact Information　(ご連絡先)

  Contact Name 
Title 
Company 
Address 
City 
State 
Zip Code 

  Work Phone 
Cell Phone 
  

  

(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。)

  
Fax 
Email 

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.
オンラインでのお支払いをご希望の方は、次のページより支払いのサイトにお進みください。

Help make this year’s tournament the most exciting yet by donating a special prize.
Foursome prizes needed!
今年のトーナメントを例年以上にエキサイティングなものにするため、特別賞品のご寄付にご協力ください。フォーサムの賞品を募集しております。

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

Prize

Quantity

Contact Representative

If you wish to donate quality items for Give-Away Bags, please provide 144 items.
参加者全員に差し上げる賞品をご寄付いただける場合は、144個分のご寄付をお願いいたします。

Comments / Requests

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