Registration due by August 5, 2011. Make checks payable to Positively Warren Golf Classic.
Mail to:
3658 Bonita View SE, Grand Rapids, MI 49508
Team/Corp. Name:____________________________________
___________________________________________________
Contact Person:_______________________________________
Sponsorship Level:_____________________________________
Printed Names as it should appear for recognition purposes:
____________________________________________________
____________________________________________________
____________________________________________________
Address:_____________________________________________
____________________________________________________
____________________________________________________
Phone Number:________________________________________
Fax Number:__________________________________________
Unable to attend, making an outright donation in the amount of:
____________________________________________________
Golfer Information:
1. Name:______________________________
Email:______________________________
2. Name:______________________________
Email:______________________________
3. Name:______________________________
Email:______________________________
4. Name:______________________________
Email:______________________________
Mail to:
3658 Bonita View SE, Grand Rapids, MI 49508
Team/Corp. Name:____________________________________
___________________________________________________
Contact Person:_______________________________________
Sponsorship Level:_____________________________________
Printed Names as it should appear for recognition purposes:
____________________________________________________
____________________________________________________
____________________________________________________
Address:_____________________________________________
____________________________________________________
____________________________________________________
Phone Number:________________________________________
Fax Number:__________________________________________
Unable to attend, making an outright donation in the amount of:
____________________________________________________
Golfer Information:
1. Name:______________________________
Email:______________________________
2. Name:______________________________
Email:______________________________
3. Name:______________________________
Email:______________________________
4. Name:______________________________
Email:______________________________
Payment Information:
__Check Enclosed
__Credit Card
Card Type:_______________________
Credit Card Number:
________________________________
Expiration Date:___________________
Billing Address:___________________
________________________________
__Check Enclosed
__Credit Card
Card Type:_______________________
Credit Card Number:
________________________________
Expiration Date:___________________
Billing Address:___________________
________________________________
POSITIVELY WARREN STEERING COMMITTEE
Marty Allen Julie Burch Jack Doles Iva Tol
Ed Elderkin Mary Ann Goode Angela Stumpo
Mark Kimball Bob Partridge Carl Paganelli
Laura Staakiewicz Cindy Tafelski Rosie Zant
Laurie Webster Rebeccah Dubicki
Registration Form
