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* 1. Player Name

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* 2. Email Address

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* 3. Course Name

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* 4. State

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* 5. Your PGA Professional's name

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* 6. Date of your 2022 Club Championship final round at your facility

Date

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* 7. 2022 Club Championship status at your facility

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* 8. Have you verified that your name is listed as a champion on pgaclubchamp.org?

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* 9. Division you won at your club

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* 10. Division you wish to compete in at 2022 PGA Club Championship

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* 11. Why do you want to compete in the PGA National Club Championship?

T