Client Information: (* Denotes Must Fill In)

* Name
Title
Company
* Street Address
* City
* State
* Zip Code
* Phone
Alt. Phone
Cell
Fax
E-mail

           Please provide the following event information requested:

Event Date:
# of Golfers:
# Dinner only Guests:
I Pledge (see packages below) :

Choose one of the following credit cards:

VISA Master Card American Express                                                                                                                   

Name as it appears on credit card:
Credit Card Number:
Expiration Date:
Code:                                                  (front of AMEX, on back of MC/VISA)

Please Bill My Credit Card This Amount:

            Select any of the following options that apply:

For Golf Check Here and Indicate Number of Golfers Below

1 2 3 4 5 6 7 8 9 10
Community Youth Center
General Support
Scholarship Fund
Endowment
New Site Development
Christ The King - Preschool Center
Christ The King - Day Care Center
Special Needs
Church Furnishings
Library
Good Samaritan (Benevolence)
Missions