7th Annual Golf Classic
Golfers Registration Form

Team Players (Name & Handicap) - (Will play as a foursome)

           1. _______________________________________
           2. _______________________________________
           3. _______________________________________
           4. _______________________________________

Individual Player (Name & Handicap) - (Will be assigned to a foursome by tournament committee)

           _________________________________________

Payment with Registration MUST be received by July 31, 2009

Check Enclosed $___________________
Make checks payable to:

Leavitt’s Mill Free Health Center
63 Main St. P O Box 47
Bar Mills, Maine 04004

Credit Cards:

VISA or Master Card  (Circle one) Amount $________________
Name on Card ________________________________
Card Number _____  _____  _____  _____
Expiration Date _______ / _______
Signature Code ___________  ___________