5th
Annual Dr. Roberts’ Fund Golf Tournament
Registration Form
Likely Place Golf Course
September 16, 2012
Registration Deadline:
September 7, 2011
Please fill out this form and return it with your payment, payable to:
Dr. Roberts’ Fund
Choose
Your Division:
[ ] Men’s
[ ] Women’s
[ ] Mixed
Number of Golfers: _________ x $75.00 each = $__________
Number of Non-golfers for dinner _________ x $20.00 each = $__________
Total Enclosed = $__________
Player Name Player Address Day Phone Number
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Sorry, I can’t attend, but I would like to make a contribution of $_______________ - enclosed.