PLAYER REGISTRATION

Full Name *

Prefix First Name Last Name

Company

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

E-mail *

Number of Players *

Player 1 *

Player 2 *

Player 3 *

Player 4 *

Sponsorship / Player Selection *

Corporate sponsor $5,000 Eagle sponsor $2,500 Birdie sponsor $1,000 Friend sponsor $500 Hole sponsor $275 Single player $100 I am unable to come, but please accept my donation. Player registration fees ($100 per player)

Player Registration Fees include green fees, golf cart, gift bag, and a BBQ lunch. Families are invited to BBQ for free. Exceptional raffle prizes available.

Please note that all sponsorships are tax deductible, including $60.00 of player registration fees.

Non-profit tax ID: 94-1026064

What payment method would you like to use for your registration or donation? *

Check Credit card

Checks can be made out to Ukiah Junior Academy with "golf tournament" on the memo line.

Please send payments by Sept. 8, 2017 to:

Glenn MIller Memorial Golf Tournament
Ukiah Junior Academy
180 Stipp Lane
Ukiah, CA 95482

Check Amount $ *

Credit card charges will be processed through the Ukiah Junior Academy account.

Credit Card Payment *

USD Amount to charge to your credit card

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

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