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2014 ~ 17th Annual Richard Clink Memorial Golf Tournament

Registration Form
Registration Deadline Saturday, August 9, 2014
To Benefit the Efforts of the Valley of Binghamton, A.A.S.R. N.M.J.

Ford Hill Country Club Sunday August 10, 2014


9:00 AM Shotgun Start
Includes: Cart Golf Dinner Fabulous Prizes * Putting Contest
Everyone is Welcome!!
Team Registration ($300)
Individual Player ($75) Committee will team you up
Team Name:__________________________________________________________________________
Captain Name:________________________________________________________________________
Address:_____________________________________________________________________________
City:_____________________________________________ State:______________________________
Day Phone: _______________________________

Night Phone: ______________________________

Email Address: ________________________________________________________________________


Team-Mate Name: _____________________________________________________________________
Team-Mate Name: _____________________________________________________________________
Team-Mate Name: _____________________________________________________________________
Sponsor a Hole for our cause !!!
Hole Sponsor ($50 per sign) -I would like to sponsor a hole. Please have my sponsor Sign read as followers:
_1.__________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_2.__________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Paid as Hole Sponsor ($50 per sign) ($50, $100, $150, Other)___________________________________
Total Enclosed __________________________________

Check # ____________________

PAYABLE TO: Childrens Dyslexia Centers Valley of Binghamton


MAIL TO: Valley of Binghamton, AASR-NM, 625 Dickson St., Endicott, NY 13760
PHONE: (607) 786 3627 EMAIL: RichardClinkMemorialGolf@gmail.com

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