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Response Form
Please complete the following form by July 12, 2004, print it and send it along with your contribution to:
Albany Institute of History & Art External Relations Division 125 Washington Avenue Albany, NY 12210
For questions or to charge by phone, contact the External Relations Department at 518-463-4478.
Format: Four-Person Scramble Tournament Fees: $1,000 per foursome/$250 per player (Foursomes are not required. Groups of less than four will be partnered to complete foursomes.)
Please reserve: # of Golfers _____x $250 each = _____
# of Non-golferst _____x $ 75 each = _____
TOTAL $ _____
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q Enclosed is a check or money order in the amount of $_________ made payable to: Albany Institute of History & Art |
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OR |
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| q Please charge the amount of $__________ to: | |
| q Visa | q MasterCard |
| q Discover | q American Express |
| Card Number:____________________________ | |
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Expiration Date:__________________________ |
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Signature:____________________________________________ |
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Golfer # 1 - Primary Contact Name ____________________________________________
Handicap ____________
Company _________________________________________
Address___________________________________________
City, State, Zip_____________________________________
Daytime Phone_____________________________________
Email ____________________________________________
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Golfer # 2 Name ____________________________________________
Handicap ____________
Company _________________________________________
Address___________________________________________
City, State, Zip_____________________________________
Daytime Phone_____________________________________
Email ____________________________________________
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Golfer # 3 Name ____________________________________________
Handicap ____________
Company _________________________________________
Address___________________________________________
City, State, Zip_____________________________________
Daytime Phone_____________________________________
Email ____________________________________________
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Golfer # 4 Name ____________________________________________
Handicap ____________
Company _________________________________________
Address___________________________________________
City, State, Zip_____________________________________
Daytime Phone_____________________________________
Email ____________________________________________
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Name(s) of non-golfer(s)
Name ______________________________________________
Name ______________________________________________
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