First Name *

Last Name *

Email Address *

Address Line 1 *

Address Line 2

City *

Zip Code *

Area Code

Phone Number

Home Phone

Fax Phone

Work Phone *

Cell Phone

Registration deadline is July 28, 2008

Please note: If you have already registered as a sponsor of the Golf Classic and submitted your golfer information, please disregard this registration form. Please use this form to register additional guests or golfers.

My golf partners are:

Please pair me with another golfer.

Ckeck one:

Payment (select one):

Credit Card #:

Name on card:

Expiration date:

Total amount to be charged:

I am unable to attend. Please accept my tax deductible donation of: