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U.S. Adaptive Open
Pinehurst Resort & C.C. (Course No. 6), Village of Pinehurst, N.C.
JULY 18-20, 2022
U.S. Adaptive Open
Pinehurst Resort & C.C. (Course No. 6), Village of Pinehurst, N.C.
JULY 18-20, 2022
Apply to Play – 2022 U.S. Adaptive Open
2022 U.S. Adaptive Open
1
Player Information
2
Handicap Index Information
3
Additional Information
4
Consent
Links:
Eligibility Information »
|
Entry Process »
General Information
The championship is open to players of all ages. Player’s date of birth is required on all USGA entry forms. An application for a player who is a minor upon the date of submission, in the state in which he/she resides (e.g., New Jersey, under the age of 18) must be submitted by a parent/guardian, and list parent/guardian’s name, phone number, and email address. The parent/guardian must agree to be bound by all terms and conditions on their behalf and on behalf of the minor player. This also applies to a player who has a permanent legal guardian.
Player Name
(Required)
First
Last
Date of Birth
(Required)
Player's date of birth is required on all USGA entry forms
Month
1
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1
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Year
2024
2023
2022
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2014
2013
2012
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1933
1932
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Indicate if the player is a minor in the state which they reside or has a legal guardian
(Required)
Yes, player is a minor
No, player is not a minor
Player is not a minor but has a legal guardian
Gender
(Required)
Select Gender
Male
Female
Player Status
(Required)
Select Player Status
Amateur
Amateur for Reinstatement (A/R)
Professional
Parent/Guardian Information
Parent/Guardian Name
(Required)
First
Last
Parent/Guardian Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Parent/Guardian Email
(Required)
Parent/Guardian Phone
(Required)
Player Contact Information
Player Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Player Email
(Required)
Player Phone
Country of Citizenship
(Required)
For non-USA players, the country of citizenship will be used for all championship printed documentation, scoring reports, media coverage, and website.
Select Country of Citizenship
United States of America
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Preferred Information
For USA players, the city and state from their address will be used for all championship printed documentation, scoring reports, media coverage, and website, unless otherwise indicated below.
Preferred City
Preferred State
Preferred State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Handicap Index Information
All players must have a Handicap Identification Number. Please confirm that your Handicap Index is active and meets the Championship requirements before completing this application. A player who applies without an active Handicap Index does not meet the Championship requirements and will be withdrawn. Please contact your golf club or local Allied Golf Association if you do not know or have a Handicap ID / GHIN Number or visit
usga.org/getahandicap
.
Country where Handicap is Established
(Required)
Select Country
United States of America
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Handicap Identification Number
The Handicap ID or GHIN Number is the number assigned to you when you sign up for a membership with an authorized golf club. The number is typically used by the golfer to post scores to their scoring record.
Club Name
(Required)
Provide your National Association Affiliation
(Required)
Handicap Index
(Required)
Handicap Identification Number
(Required)
The Handicap ID or GHIN Number is the number assigned to you when you sign up for a membership with an authorized golf club. The number is typically used by the golfer to post scores to their scoring record.
Note: Your handicap index must be 36.4 or lower to be eligible to compete in this championship.
Additional Information
Impairment Category
(Required)
Please select the category most closely related to your impairment. If you would like to provide further explanation, you will be able to in the "Description of Disability" box. Final Impairment Category placement will be determined by the USGA, in consultation with the medical assessor.
Select Impairment Category
Arm Impairment
Leg Impairment
Multiple Limb Amputee
Vision Impairment
Intellectual Impairment
Neurological Impairment
Seated Players
Short Stature Players
WR4GD Pass
(Required)
Please provide your WR4GD Pass number. For more information on a WR4GD Pass, please go to:
https://edgagolf.com/online/pass/pass_info.php
.
If you have been assessed for and/or received a WR4GD Pass, but don’t know your WR4GD Pass number, please contact
[email protected]
.
If you have never been assessed for a WR4GD Pass, please go to:
https://edgagolf.com/online/pass/pass_info.php
.
A WR4GD Pass is required to enter this championship.
Virtus II1 Number
(Required)
A Virtus II1 Number is required for players to be eligible to compete under the Intellectual Impairment Category. More information can be found at:
https://www.virtus.sport/applying-for-athlete-eligibility
Description of Disability
(Required)
Please describe your disability with as much detail as necessary.
Do you play golf in a cart adapted for seated players?
(Required)
Yes
No
Description of Adaptive Equipment (Optional)
Please describe any other adaptive equipment (prosthetics, devices, etc.) you use to play golf.
Equipment Photo Upload (Optional)
Please upload photos of any adaptive equipment (prosthetics, devices, etc...) you use to play golf. You can upload up to 5 photos.
Drop files here or
Select files
Max. file size: 50 MB, Max. files: 5.
Please list competitive playing record from the last two years, for example, tournaments and finishes, awards, honors, etc.
(Required)
Agreement
Consent
(Required)
Whether I am filling out this entry on behalf of the player or for myself, I have the authority to prepare and submit this entry and I have read and agree with the preceding conditions as set forth, including the Championship Regulations.
I agree
Notice Regarding Covid-19:
Each individual player is responsible for understanding and complying with any travel restrictions and quarantine requirements and recommendations at the time of the competition. Please familiarize yourself with the requirements and guidelines for any state you may be traveling to or from before registering.
COVID-19 Playing Site Protocol
(Required)
Players may be prohibited from participating in a USGA championship if they test positive for COVID-19 or exhibit COVID-19 symptoms. Players who are unable to participate in a USGA championship due to COVID-19 will be refunded their entry fee.
All players who make the final field of a USGA championship will be required to follow all mitigation measures implemented by USGA with respect to COVID-19. These requirements are a condition of competition for all players. In particular, players, caddies and others attending a USGA championship may be required to submit to COVID-19 testing prior to arrival and on-site upon arrival at the championship, follow on-site protocols established by the USGA and comply with limitations set by the USGA on allowing guests at the championship.
I have read, understand and agree to the preceding requirements.
I agree
Sharing of Personal Information with Other Golf Related Organizations
(Required)
In addition to the use of your Personal Information as identified in the USGA Privacy Policy, by checking the Opt-In box below, you agree that the USGA may also share your personal information with other golf related organizations, including those conducting golf events. There are many benefits you'll enjoy (see below) when you decide to Opt-In, but it is not mandatory for you to do so for your entry application to be processed. If you Opt-Out, you will still receive correspondence and communications from us relating to the Championship.
The benefit of allowing the USGA to share personal information, such as your email address, with other golf related organizations including golf competition organizers, when requested, is that such organizations may provide you with helpful information regarding upcoming golf events.
Opt-In
Opt-Out
The USGA cannot, and does not, make any guarantee that an entry submitted pursuant to this website will be received by the USGA or received in a timely fashion. The USGA shall have no liability with respect to any such delay and/or error and the consequences therefrom, including rejection of an entry. Entries will be automatically rejected by the USGA if received after the date and time set forth on the relevant entry form. Entries submitted with incorrect information or insufficient information may not be transmitted to the USGA. The online application process is not complete until you reach a screen indicating "Your entry has been received." This screen will have a unique ID number on it which you should retain for your records. Please note that this number indicates a receipt of application which will be confirmed by e-mail. The information provided on your entry will be verified, and if the entry is not accepted, you will be notified.
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