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Our Mission: To stop impaired driving
and to support victims of this violent crime

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Golf Tournament Registration Form

Please complete and submit the form below and visit Golf Tournament Online Payment to use your credit card to pay for dinner and golf registration fees - note that by completing this form you will be automatically taken to the online payment web page. If you are paying by cash or cheque, please indicate this on the form and mail/bring in* your payment for the tournament.

*do not send cash through the mail

Please provide the following contact information:

Golfer One

NAME			CHICKEN STEAK
ADDRESS
CITY		PROV	P/C
PHONE		EMAIL
PAYMENT	CASH CHEQUE AMEX MASTERCARD VISA CHEQUE IN THE MAIL
ONLINE CREDIT CARD REGISTRATION PAYMENTS MUST BE PROCESSED THROUGH PAYPAL I HAVE PAID VIA PAYPAL

Golfer Two

NAME			CHICKEN STEAK
ADDRESS
CITY		PROV	P/C
PHONE		EMAIL
PAYMENT	CASH CHEQUE AMEX MASTERCARD VISA CHEQUE IN THE MAIL
ONLINE CREDIT CARD REGISTRATION PAYMENTS MUST BE PROCESSED THROUGH PAYPAL I HAVE PAID VIA PAYPAL

Golfer Three

NAME			CHICKEN STEAK
ADDRESS
CITY		PROV	P/C
PHONE		EMAIL
PAYMENT	CASH CHEQUE AMEX MASTERCARD VISA CHEQUE IN THE MAIL
ONLINE CREDIT CARD REGISTRATION PAYMENTS MUST BE PROCESSED THROUGH PAYPAL I HAVE PAID VIA PAYPAL

Golfer Four

NAME			CHICKEN STEAK
ADDRESS
CITY		PROV	P/C
PHONE		EMAIL
PAYMENT	CASH CHEQUE AMEX MASTERCARD VISA CHEQUE IN THE MAIL
ONLINE CREDIT CARD REGISTRATION PAYMENTS MUST BE PROCESSED THROUGH PAYPAL I HAVE PAID VIA PAYPAL