Personal Information
Company:
Contact Name:
Address (Location):
City/Town:
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Telephone:
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GOLFER REGISTRATION (includes golf, cart, reception and dinner)
#1 Golfer Name:
#1 Golfer Phone Number:
#2 Golfer Name:
#2 Golfer Phone Number:
#3 Golfer Name:
#3 Golfer Phone Number:
#4 Golfer Name:
#4 Golfer Phone Number:
Golf Registration - includes Reception, Dinner, Cart + Green Fees: $185 + HST
($209.05)
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Afternoon Reception & Dinner Only: $50 + HST
($56.50)
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Credit Card Payment Information
Name on Credit Card:
Credit Card #:
Credit Card Type:
MasterCard
Visa
American Express
Expiry Date:
01
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2010
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