REGISTRATION FORM (print and mail)
Please return completed form with payment by May 25, 2006.
Name ___________________________________________________
Company _________________________________________________
Address __________________________________________________
Phone _____________________ Fax ___________________________
My foursome will be:
Name____________________________________________________________________
Name____________________________________________________________________
Name____________________________________________________________________
Name____________________________________________________________________
# for BBQ Only @ $25__________ Name (s)
_____________________________________________
# golfers @ $120 ____________ # golfers @ $150 ____________ Total
Remittance $ ______________
__ Check enclosed or charge to __ MasterCard __ VISA
Account No.: ______________________________Exp. Date: _______
Cardholder Name _____________________________
Signature X ______________________________
Send to: VMBA, P. O. Box 8503, Essex, VT 05451.
For more information contact the VMBA at 802-879-0334.
Mail form to VMBA, P. O. Box 8503, Essex, VT 05451