| Name | |
| Company | |
| Address 1 | |
| Address 2 | |
| City | |
| Province/State | |
| Postal Code | |
| Telephone | |
| Fax |
| Event | Price | Quantity | Total |
| Golf | $150.00 | ||
| Hole Sponsorship (per Hole) | $150.00 | ||
| TOTAL (CDN) | |||
| SHIRT SIZE | SMALL | MEDIUM | LARGE | X-LARGE | XX-LARGE |
| PROVIDE PRIZE | YES | NO | |||
| FLIGHT | MORNING (8:00 AM) | AFTERNOON (12:45 PM) | |||
| Card Number | |
| Expiry Date | |
| Signature |