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Registration Form

Four Man Teams


Team Name_________________________________________
First Name: ____________________ Last Name: ____________________Email__________________
Address:

_____________________City:____________State:______Zip Code: _______

First Name: ____________________ Last Name: ____________________ Email__________________


Address:

_____________________City:____________State:______Zip Code: _______

First Name: ____________________ Last Name: ____________________ Email__________________


Address:

_____________________City:____________State:______Zip Code: _______

First Name: ____________________ Last Name: ____________________ Email__________________


Address: _____________________City:____________State:______Zip Code: _______
(We need your Address to send you a receipt for your Taxs)

POC Name _____________________


Address______________________
City ______________ State _______ Zip Code_______
Contact Phone #_________________
Email Address___________________
Make checks Payable to

Keowee Lodge #79

Mail completed form and Check to:


Keowee Lodge #79
P.O. Box 1045
Pickens, SC 29671

Cost: $65.00 per player or $260.00 for Teams

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