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Presents:

5th Annual ElderCare of Alachua County Golf Tournament


November 16th, 2012
Haile Plantation Golf and Country Club
Gainesville, FL

Registration Fee:

Individual $125

or

Foursome $500

To confirm your golf registration, please complete the form below and return to
Anthony Clarizio at claria@shands.ufl.edu or fax to (352) 265-9334
no later than November 9th, 2012.
For questions or further information please call (352) 265-9206.
Proceeds will go towards our Meals on Wheels program
and Alz Place, Adult Day Care.

Player #1

Player #2

Name ______________________________________________

Name ______________________________________________

Company __________________________________________

Company __________________________________________

Address ___________________________________________

Address ___________________________________________

City ____________________________ Zip ______________

City ____________________________ Zip ______________

Phone _____________________________________________

Phone _____________________________________________

Email ______________________________________________

Email ______________________________________________

Player #3

Player #4

Name ______________________________________________

Name ______________________________________________

Company __________________________________________

Company __________________________________________

Address ___________________________________________

Address ___________________________________________

City ____________________________ Zip ______________

City ____________________________ Zip ______________

Phone _____________________________________________

Phone _____________________________________________

Email ______________________________________________

Email ______________________________________________