2024 Japan Golf Tour Organization
Qualifying Tournament Entry Form

This document is for your reference only.
You MUST use the Original Japanese Entry Form.
I hereby apply to participate in the Tournament conducted by Japan Golf Tour
Organization (JGTO) using this entry form.
I declare that I have carefully read and understood the guidelines and regulations ofthe Japan Golf Tour Organization Qualifying Tournament, agree that the Tournament
will be held in accordance therewith and agree to obey all of them.
I hereby agree to transfer without any compensation my personal pictorial
reproductive right as well as my intellectual property right to JGTO as stated inRegulations of the guidelines of the Tournament and agree to license the use of therights.
I also agree that any part of my personal information shown below will be given to
any party in accordance with Note (16) of the regulations.

Please PRINT clearly and legibly.
1. Applicant’s Full Name

(Last Name)(First Name)

Signature

2. Name in Chinese Character, if applicable:

3. Name in Alphabet (phonetic):
4. Date of Birth & Age(Year)(Month)

5.Address in JAPAN (to be given in full)

6.Telephone Number (in JAPAN) :7.Fax Number (in JAPAN if any):

(Day)

(Age)

8. Mobile phone number or the like you can be reached at

9. E-mail address if you have one

10. Do you reside in Japan?
YesNo(Please circle one.)

If non-resident, specify your nationality (option) :11. Entry qualification category eligibility: Write down your eligibility category
number in the applicable box. Be sure to give only one even if you have more than
one eligibility category number.
First Qualifying Second
ThirdFinalStage
Qualifying Stage Qualifying
Qualifying
StageStage
Eligible(➀ to⑥)(② to ⑬)(② to ⑬)(② to ④)
Category

12. Preferred venues① Applicants entering from the First Qualifying Stage must fill in the boxes
up to 9th Choice.
② Applicants entering from the Second Qualifying Stage must fill in theboxes up to 5th Choice.
③ Applicants entering from the Third Qualifying Stage must fill in the boxes
up to 3rd Choice.
Note: If the boxes are left blank, appropriate venues will be assigned by theQualifying Tournament Executive Committee.
1st Choice

2nd Choice

3rd Choice

6th Choice

7th Choice

8th Choice

4th Choice5th ChoiceThis part is to be used byJGTO.
Acceptance Number:

About issuing receipts

Put Glue Here
Affix Copy of Entry Fee Remittance Slip (Makesure that the remitter’s name is provided.)
Put Glue Here
Affix Handicap Certification****************************************************************************************

Proof of Qualification
I hereby prove that the player specified as the applicant in the application form
is a qualified participant who meets the requirements specified in theGuidelines of 2022 Japan Golf Tour Organization Qualifying Tournament.
Name of organization applicant is affiliated with:
Name of person representing organization:
Signature:
Note: Participants Qualified for First Qualifying Tournament (1) ⑤
Please indicate the school name and the grade level for the current student.
School name
Grade level****************************************************************************************

Amateur Status
Any amateur participant must affix his/her signature in the blank below.
Failure to do so will cause the loss of Amateur Status at the Qualifying
Tournament in violation of the Rules of Amateur Status.
I hereby agree not to receive any prize money from the Qualifying
Tournament.
Signature****************************************************************************************

Identification Contact Person
Name of contact person who lives in Japan and speaks Japanese:
Signature or Seal
Address in Japan only:
Telephone Number in Japan only:

Note: Any player who does not reside in Japan must have aidentification contact person and have him/her fill out theabove sections.