The cost includes: Golf, Cart, and BBQ buffet, 1^st, 2^nd, and 3^rd Place Prizes, Raffle, and Live Entertainment after the tournament!!!

            PLAYER / TEAM INFORMATION  

Single Player or Team Captain Name:  ______________________________________________*_____

Address:  ___________________________________________________________________________

                            ___________________________________________________________________________

Phone Number:  ______________________________________________________________________

Email Address:  ______________________________________________________________________

Teammates:

____________________________________*____     __________________________________*_____

____________________________________*____

* 9 Hole Handicap (best guess)

METHOD OF PAYMENT

Payment of:  $____________________                                  Type of Payment: ______ Cash

                                                                                                                            ______ Check

________________________________                                Date:  _____________________

Authorized Signature

________________________________

Print name

________________________________