Name:
Address:			$25 2 MULLIGANS:
Company:	Handicap

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Name:
Address:			$25 2 MULLIGANS:
Company:	Handicap

---

Name:
Address:			$25 2 MULLIGANS:
Company:	Handicap

---

Name:
Address:			$25 2 MULLIGANS:
Company:	Handicap

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Golfer(s) x $350 = Foursome(s) x $1,400 = Mulligans: $ Sponsor(s) x $250 = Grand Total $

Please note that credit card processing will occur at time of registration

Credit Card	VISA MasterCard American Express Discover Cardholder Name:
Card Number  (No Spaces Please)	Expiration Date:      (MM/YY)

If paying by check make payable to: American SIDS Institute
(Tax deduction as allowed by law)