Registration Make-A-Wish Atlantic 2012

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- Team
- Individual
- Sponsorship
- Donation

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Registration Make-A-Wish Atlantic 2012

  1. 1. Homburg Charity Golf Challenge 2012In support of Make-A-WishSherwood Golf & Country Club, Chester, NSWed. Sept 12, 2012 5991 Spring Garden Road, Suite 605, Halifax, NS B3H 1Y6 P 902-466-9474 F 902-466-0602 www.makeawish-atl.caRegistration/SponsorshipPlease return by fax: (902) 466-0602 Or E-mail: daphne.carter@makeawish.ca Primary Point of Contact Name: Daytime Phone: Email: Company: Team Captain Name: Billing Address: City: Prov. PC: Team Name (if any): NOTE: Registration fee due by Wed. Sept 5th Team Members (if known): 1. 2. 3. 4.Participation Options: A.) Full Team (4) $1000 x ____ = $ B.) Individual Player $250 x ____ = $C.) Sponsorship Level: =$ D.) Donations: = $ Donations are eligible for a (available upon request) charitable tax receiptPayment Options: A.) By Credit Card: B.) By Invoice: C.) By Cheque: (Payable to “Make-A-Wish Atlantic”)Credit Card Type _ ___ (Visa, MC, AMEX) Card # ______________ _____________________ Exp. Date / (Mon / Year)Signature of Card Holder:

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