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Welcome to the DMC GUILD
Golf Outing Reservation Form
Monday July 16, 2007
Detroit Golf Club
* required fields
Golf Information:
Please reserve space(s)
x $395.00 per person, total of $
Registration starts at
8:00 AM with a continental breakfast. Lunch and beverages will be offered on the course.
Shoot Gun starts at
10:00 AM
Cocktails, Dinner and Awards start at
5:00 PM
Course Preference
(not guaranteed)
Personal Information:
First Name:
*
Last Name:
*
Address:
*
City:
*
State:
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
Zip Code:
*
Phone:
*
Email:
*
Donation Information:
Dinner Only Ticket:
x $100 each, total of $
I am unable to attend,
but I would like to donate:
$
I would like to donate a door prize:
$
I would like to be a hole sponsor for $150
I would like to be a cart sponsor for $25
I would like to purchase advertisement in the DMC Guild Annual Recognition Booklet. Please contact me.
Payment Information:
Total Amount:
$
*
Method of Payment:
Master Card
Visa
*
Name on Card:
*
The same as the above
Credit Card Number:
*
Exp. Month:
01
02
03
04
05
06
07
08
09
10
11
12
*
Exp. Year:
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
*
CVC:
* (last 3 digits in signature space on back of card)
Reservations will be held at the door.
MICS 11200
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2005
Detroit Medical Center
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