2016

Anastasi Jellum Charity Golf Event Registration Form

Name of Organization/Business (As it will appear on promotional material)

Golfer names rental clubs (left or right) Golfer names rental clubs (left or right)

Contact Name:

Mailing Address:

City/State/Zip:

E-mail Address: Phone:

Method of Payment: Check is enclosed

Type of card: Visa Mastercard

Credit Card

American Express Discover

Name on card:

Credit card number: Exp. Date:

If you would prefer to give your credit card number over the phone, please call Lindsay Kedzuf at 612-775-2584.

Please make checks payable to Courage Kenny Foundation and send to:Courage Kenny FoundationAttn: Lindsay Kedzuf3915 Golden Valley RoadMinneapolis, MN 55422

For questions, please contact: Deb O'ConnorDeb.OConnor@aj-law.com 651-332-8315

Yes, I/we would like to participate in the 2016 Anastasi Jellum Charity Golf Event!

Please select the registration category:

Individual $150.00

Foursome $600.00

Dinner Only $35.00

http://donate.allina.com/AnastasiJellumGolfRegistration