20th Annual CareFlite Golf Tournament Thursday October 3, 2013, 8 ...

20 th Annual CareFlite Golf Tournament RegistrationThursday October 3, 2013, 8:30am ♥ Four Person ScrambleTour 18 ♥ 8718 Amen Corner ♥ Flower Mound, Texas 75022Registration must be received at CareFlite on or before 9/30/13Name: ____________________________________Address: _____________________________________City: ______________________ Zip Code: ___________ Phone: (_______) _________________Email: _____________________________@_________________ . __________Fee $85 □ With $5 Mulligan □ Amount Enclosed $ ___________(Note: Fee is $95 if paid at the door)Name: ____________________________________Address: _____________________________________City: ______________________ Zip Code: ___________ Phone: (_______) _________________Email: _____________________________@_________________ . __________Fee $85 □ With $5 Mulligan □ Amount Enclosed $ ___________(Note: Fee is $95 if paid at the door)Name: ____________________________________Address: _____________________________________City: ______________________ Zip Code: ___________ Phone: (_______) _________________Email: _____________________________@_________________ . __________Fee $85 □ With $5 Mulligan □ Amount Enclosed $ ___________(Note: Fee is $95 if paid at the door)Name: ____________________________________Address: _____________________________________City: ______________________ Zip Code: ___________ Phone: (_______) _________________Email: _____________________________@_________________ . __________ (Note: Fee is $95 if paid at the door)Fee $85 □ With $5 Mulligan □ Amount Enclosed $ ___________Entire Form Total Amount Enclosed: $ ________(Note: Fee is $95 if paid at the door)Please complete this form, enclose check and mail to:CareFlite Golf Tournament, 3110 S. Great SW Pkwy, Grand Prairie, Texas 75052If paying by credit card, please fax this form to (972) 602-7182□ Visa □ Master Card □ Discovery □ American Express Credit Card # _____________________ Expires ____ /____Name on Card: _____________________ Address: ________________________________ Phone (____)____________For further information: please contact Laura Thompson (972) 339-4248 or lthompson@careflite.org