Please fill out this form COMPLETELY. The fee is $280 per team. Limit of 72 teams. Registration deadline is 12:00 noon central time on Tuesday, July 7th.

Team Name:*

Golfer #1 (Team Captain)

First Name: *

Last Name: *

Address: *

City: *

State: *

ZIP Code: *

Phone: *

Email: *

Meal Location: *

Golfer #2

First Name: *

Last Name: *

Address: *

City: *

State: *

ZIP Code: *

Phone: *

Email:

Meal Location: *

Golfer #3

First Name: *

Last Name: *

Address: *

City: *

State: *

ZIP Code: *

Phone: *

Email:

Meal Location: *

Golfer #4

First Name: *

Last Name: *

Address: *

City: *

State: *

ZIP Code: *

Phone: *

Email:

Meal Location: *