Text Box: Player Registration

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Text Box: Phone: 401 722 4626    Fax: 401 727 2967       Email: childrensshelter@cox.net

Text Box:                           Individual or Team Entry Form         Space is limited, payment in full is due no later than August 23, 2010  $140 per person      Make check payable to:  CSBV Golf Tournament                                                                       15 Gates Street  or                                                                  Pawtucket, RI 02861  please charge my payment to:  _____        _____                           ______________________/_______     _____________________________  Acct #                                  Exp date      Signature           Name on credit card _________________________________                Address      _________________________________                                     _________________________________      *     *     *     *     *    GOLFERS *     *     *     *     *     * __________________________________________________________________    Golfer 1___________________________________________ Address___________________________________________ City______________________ State______ Zip___________ Phone (H)___________________ (Work)________________ Email_____________________________________________ ____________________________________________________________________   Golfer 2___________________________________________  Address__________________________________________  City______________________ State______ Zip__________  Phone (H)___________________ (Work)________________  Email_____________________________________________  ____________________________________________________________    Golfer 3___________________________________________  Address__________________________________________  City______________________ State______ Zip__________  Phone (H)___________________ (Work)________________  Email_____________________________________________  ____________________________________________________________________    Golfer 4___________________________________________  Address__________________________________________  City______________________ State______ Zip__________  Phone (H)___________________ (Work)________________  Email_____________________________________________