Foursome. $600. $650. $700. $. Twosome. $300. $350. $400. $. Single. $175. $195. $220. $. Type of Credit Card. O. O. Cre
Proceeds from this event to benefit a 501 (c)(3) a Non Profit Organizacion
REGISTRATION Date: Thursday, October 6th, 2016 Place: Weston Hills Country Club (2600 Country Club Way, Weston FL 33332) Registration: 10:00 am Shotgun: 12:00 pm
Scramble Format Prices, raffles and lots of fun Trophies: 1st, 2nd and 3rd Place
COMPANY INFORMATION Company Name: Contact Name: Address: Phone: Email:
PLAYERS INFORMATION NAME
E-MAIL
PHONE
Member
NonMember
Stand-By
Foursome
$600
$650
$700
Twosome
$300
$350
$400
Single
$175
$195
$220
10% Discount if you pay before September 8th
Player Amount: $ Other donation: $ Discount: TOTAL AMOUNT DUE: $
NOTICE: Full refund will be made within 72 hours of payment. After 72 hours NO REFUNDS will be process.
PAYMENT Type of Credit Card Credit Card number: Name on card: Address: City / State / ZIP:
Signature:
O
O
O
Cash or Check: Expires: / CVS:
X ______________________________________________
Please make checks payable to Venezuelan American Chamber of Commerce, and mail to the following address: 1600 Ponce de Leon Blvd., Suite 1033, Coral Gables, FL 33134 or send it via email
[email protected]