Benefit Golf Outing for

Johnny Brawley
Saturday, October 10, 2009
Shot Gun Start at 9:30 a.m.
Hampshire Country Club
29592 Pokagon Hwy
Dowagiac, MI

Team Captain ____________________________ Player #2 _________________________________

Address _________________________________ Address _________________________________
Phone __________________________________ Phone __________________________________
E-mail ____________________________________ E-mail ___________________________________

Player #3 ________________________________ Player #4 _________________________________

Address _________________________________ Address _________________________________
Phone __________________________________ Phone __________________________________
E-mail ____________________________________ E-mail ___________________________________
 I would like to play, but do not have a team. Please place me on a team.
 I would like to donate gift certificates or other items to be used for prizes and/or raffles.
Please contact me.
 I would like to volunteer my time/talents on the day of the event. Please contact me.
Name ____________________________________
Address __________________________________
Phone ____________________________________
E-mail ___________________________________

Cost is $50 per player

Please mail completed form and a check payable to Larry Larson to:
Express-1
c/o Larry Larson
429 Post Rd
Buchanan, MI 49107