Player Registration Form                 

PM SHOTGUN START ONLY!   Sign-Up Early!!

 

$125 PER PERSON

Please Print Clearly

Company Name___________________________________________________________________________

Address_________________________________________ City__________________ State_____ Zip______

Contact Name_____________________________ Phone__________________________________________

 

           Players                                                                FLITE

1.______________________________________________________________________________________

2.______________________________________________________________________________________

3.______________________________________________________________________________________

4.______________________________________________________________________________________

Payment Method:

                        Check enclosed (payable to Lanie Hannah Benefit Scramble)

                          Visa               MasterCard

                        Name on Card ________________________________________________

                        Credit Card No. ________________________ Exp. Date _______________

                        Signature _____________________________________________________

 

#             You do not need a whole team to play.

#             NO REFUNDS AFTER SEPTEMBER 1, 2006.  

#             Mail Player Registration Form and payment to: LHBS, PO Box 57, Dennis, TX 76439

For More Information Please Call: Chris Hannah @ 817-613-6658