Golf Outing Registration

Benefit Golf Outing for Johnny Brawley Saturday, October 10, 2009 Shot Gun Start at 9:30 a.m. Hampshire Country Club 29592 Pokagon Hwy Dowagiac, MI Team Captain ____________________________

Player #2 _________________________________

Address _________________________________

Address _________________________________

Phone

Phone

__________________________________

__________________________________

E-mail ____________________________________

E-mail ___________________________________

Player #3 ________________________________

Player #4 _________________________________

Address _________________________________

Address _________________________________

Phone

Phone

__________________________________

E-mail ____________________________________

__________________________________

E-mail ___________________________________

 I would like to play, but do not have a team. Please place me on a team.  I would like to donate gift certificates or other items to be used for prizes and/or raffles. Please contact me.  I would like to volunteer my time/talents on the day of the event. Please contact me. Name ____________________________________ Address __________________________________ Phone ____________________________________ E-mail ___________________________________

Cost is $50 per player Please mail completed form and a check payable to Larry Larson to: Express-1 c/o Larry Larson 429 Post Rd Buchanan, MI 49107