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'[email protected] 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
