Winner’s Full Name
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Winner’s Email
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Winner’s Phone Number
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Reporter's Full name
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Reporter's Phone number
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Reporter’s Email
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Event Start Date
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Tournament Name
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Golf Course Name
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Golf Course City and State
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Golf Pro /Course Contact Name
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Golf Pro/Course Contact Phone Number
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Hole #
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Yards
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What type of claim is this?
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Prize Won
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Contract/Affidavit/Order Number
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Additional Comments
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