Christiana Rotary - Registration

GOLF:
Individual(s)	x $195 =
Foursome(s)	x $780 =

SPONSORSHIPS:
Tee Sponsorship	x $100 =
Green Sponsorship	x $100 =

DONATIONS:
I can't attend, but wish to support this event

TOTAL

Make checks payable to "Christiana Rotary Club Foundation"

or use your credit card

CREDIT CARD NUMBER

EXP. DATE

NAME AS IT APPEARS ON CARD

__MASTERCARD __VISA __ DISCOVER __ AMERICAN EXPRESS

As holder of the above credit card, I authorize the amount shown in the TOTAL column to be charged to my credit card on May 21, 2009

Signature: Date:

SUBMIT REGISTRATION FORM

Fax To: (302) 995-7980 or Mail To:

Christiana Rotary

c/o Dewberry Insurance Agency

5700 Kirkwood Highway, Suite 103

Wilmington, DE 19808

TELEPHONE INFORMATION

(302) 995-9550

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