Golfer Registration Form
(please print and complete this form)

Name ____________________________________
Company__________________________________
Address___________________________________
Phone____________________________________

Name ____________________________________
Company__________________________________
Address___________________________________
Phone____________________________________

Name ____________________________________
Company__________________________________
Address___________________________________
Phone____________________________________

Name ____________________________________
Company__________________________________
Address___________________________________
Phone____________________________________

Registration Costs
Individual—$125
4-some—$500

Pre-purchase Raffle Tickets
$20 per set of 15

# of Golfers ____ x $125= Golf Total _______

                                                Raffle Total _______

                        TOTAL ENCLOSED _______

 

 


Method of Payment
(Please check one)

Check (Check #________)
MasterCard_____      Visa_____    Discover _____

Card #__________________________exp_____

Signature________________________________

Printed Name_____________________________

Address__________________________________

Phone___________________________________

Please make checks payable to:
American Red Cross
Middlesex Central CT Chapter

Mail this form to:
97 Broad Street
Middletown, CT 06457

Or Fax to: (860) 346-1869

 

Thank you for your support!