Payment Form

Driving for Driving Miss Darby Golf Tournament and Party Saturday May 30, 2009 Heritage Isles at 10630 Plantation Bay Drive in Tampa, Florida Golf Tournament: Shotgun start at 1:00 pm All golfers receive free admission to the party. Please indicate if you intend to come. Your name(s) will automatically be on the party list, but we want to get an idea of who is coming. □ $500.00 Foursome □ Foursome Pay at Course, this will reserve your spot in the tournament. □ $150.00 Individual □ Individual Pay at Course, this will reserve your spot in the tournament. □ $20.00 10 Mulligans □ $10.00 each. Memorial Signs. Please include the full name as you want it to appear on the sign. □ $100.00. Hole Sponsorship Please include an email address where we can reach you to discuss signage. Tournament Party: 8:00 pm at Heritage Isles Clubhouse Please include the names of everyone you are paying for. □ $40.00 Admission to the party. □ Golfers receive free admission to the party, but we still need your RSVP to the party listed below. Name(s) of the golfer(s) and team name if applicable: Name, Email, Daytime Phone Number Team Name: 1. 2. 3. 4. Memorial Signs:

Sponsorship Signs and email address:

List the name of each person attending the party here:

□ I am enclosing a check for ____________. Please indicate the email address we can send a receipt confirmation to: ____________________________. We can also accept donations made out to “Driving Miss Darby.” Amount of donation:___________. Email address for confirmation:____________________________. Make all checks payable to “Driving Miss Darby” Please fill out and mail to: Driving for “Driving Miss Darby” c/o Carrie Larson 3302 W Pearl Ave Tampa, Florida 33611