Forget-A-Hole For Alzheimer’s Golf Tournament

In support of the
Hamilton and Halton
Alzheimer Foundation

TUESDAY, SEPTEMBER 21st 2010

Lowville Golf Club
REGISTRATION FORM
Fee: $125 per person includes green fee for 18 hole game, power cart,
lunch, game card and dinner reception

Team : _________________________________________________________
(you may register individually or as a team)

GOLFER 1
Name: __________________________________________________________

Company: _______________________________________________________
If applicable

Phone :____________________________ Fax: _________________________

Street Address: ___________________________________________________

City: _______________________________ Postal Code: _________________

Email Address : ___________________________________________________

GOLFER 2
Name: __________________________________________________________

Company: _______________________________________________________
If applicable

Phone :____________________________ Fax: _________________________

Street Address: ___________________________________________________

City: _______________________________ Postal Code: _________________

Email Address : ___________________________________________________

GOLFER 3
Name: __________________________________________________________

Company: _______________________________________________________
If applicable

Phone :____________________________ Fax: _________________________

Street Address: ___________________________________________________

City: _______________________________ Postal Code: _________________

Email Address : ___________________________________________________

GOLFER 4
Name: __________________________________________________________

Company: _______________________________________________________
If applicable

Phone :____________________________ Fax: _________________________

Street Address: ___________________________________________________

City: _______________________________ Postal Code: _________________

Email Address : ___________________________________________________

REGISTRATION IS PAYABLE BY VISA, MATERCARD, CHEQUE OR CASH

Method of Payment: VISA MASTERCARD CHEQUE
Card Number : _________________________________ Expiry Date : _________

AMOUNT: $ _______________________ (golfers may pay individually or as a team)

For security reasons, please do not email any credit card information

PLEASE MAKE ALL CHEQUES PAYABLE TO “Forget-A- Hole”

Registration Forms and payment must be received no later than AUG. 17th 2010
Sunrise Senior Living of Burlington
5401 Lakeshore Rd
Burlington, ON L7L 6S5
Phone: 905-333-9969 ext 6771 Fax: 905-333-3199
Email: forget-a-hole-golf@hotmail.com