REGISTRATION

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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]