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Registration Form

Register before May 1st, 2008 &

SAVE $25/Person off your Registration Fees!

Date of Event: July 15, 2008

Crystal Lake Golf Course

16725 Innsbrook Drive, Lakeville, MN 55044

Registration: 9am to 10am Shotgun Start: 11am

Luncheon, Awards and Silent auction to follow Golf!

Cost: $150/person (OR $125/person when register before May 1st!)

Team: $600/team (OR $500/team when register before May 1st!)

Hole Sponsorship: $200 Get your logo on website, all print material and posted on one of the 18 holes during the Charity Golf Event!

Questions?

Participant Information:

Name
Company
Address
City, State
Zip
Day Phone
Cell Phone
E-mail

Team Information:

Team Name (foursome)

Player Two
Address
City, State
Zip
Day Phone
Cell Phone
E-mail

Player Three
Address
City, State
Zip
Day Phone
Cell Phone
E-mail

Player Four
Address
City, State
Zip
Day Phone
Cell Phone
E-mail

Payment Information:

Player Type (visa/mc/discover)
Card Number
Exp Date
Card Holder Name
Day Phone
Cell Phone
Payment Signature (type name here - serves as authorization)

Waiver:

I hereby waive all claims against Southside Life Care Center, Fireside Pizza, sponsors or personnel for any injury that I may suffer from my participation in this event. I grant full permission to use photographs in which I may appear for legitimate reasons.

Waiver Signature (type name here - serves as authorization)