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2. Team Registration

   Complete this form by August 30th to ensure that a spot will be reserved for your team!  Please choose a lunch sandwich provided by The Shack by checking one choice for each player.

4. Team Captain - Player 1*
5. Mailing Address*
7. Phone*
8. Fax
9. Email*
11. Sandwich Option*
    -- Select One --ChickenSteak
13. Is there a 2nd Player*

    1. Yes
    2. No
17. Player 2*

    Last Name, First Name

18. Mailing Address*
20. Phone*
21. Fax
22. Email*
24. Sandwich Option*
    -- Select One --ChickenSteak
26. Is there a 3rd Player?*

    1. Yes
    2. No
30. Player #3
31. Mailing Address*
33. Phone*
34. Fax
35. Email*
37. Sandwich Option
    -- Select One --ChickenSteak
39. Is there a 4th Player

    1. Yes
    2. No
43. Player #4
44. Mailing Address*
46. Phone*
47. Fax
48. Email*
50. Sandwich Option
    -- Select One --ChickenSteak
54. Hole Sponsorship - $100 - Sign Will Be Placed On Designated Hole Showing Your Support!
56. Would you like to be a hole sponsor?

    1. Yes
    2. No
58. Sponsorship *
60. Door Prize Donations

    ** Prizes will be distributed to Golfers helping to make this tournament a great success!  Just call 276-328-3566 and someone will come by and pick up your donation.  **  

62. Would you like to donate a door prize?

    1. Yes
    2. No
64. Phone Number*
66. Payments

    Please make checks payable to DRUG ED FUND and mail to P.O. Box 916, Wise, VA. 24293

Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit Submit and Print

* indicates a required field