S p e e d w ay C h i l d r e n ’s C h a r i t i e s A n n u a l
Wednesday,
September 13
Eagles Brooke Golf & Country Club
300 Lester Mill Rd
Locust Grove, GA
30248
Presented by
PLayer Registration Form
Registration: 8:30 a.m.
/
Shotgun Start: 10:00 a.m.
Team/Player Information
Registration fee includes green fees, cart, snacks, meal and awards ceremony.
☐ Individual Player.......................... $125
☐ Foursome....................................... $475
☐ Two Players.................................... $250
☐ Mulligan........................................... $10
☐ Three Players................................ $375
☐ Mulligan Value Pack................... 3/$20
Team Name _ __________________________
Player 1 _______________________________
Captain Name__________________________
Player 2_______________________________
Captain’s Phone ________________________
Player 3 _ _____________________________
Captain’s Email _ _______________________
Signature _____________________________
Player 4 _ _____________________________
Contact Info
Payment Options
☐ Debt ☐ Discover ☐ Visa
☐ MasterCard
☐ American Express ☐ Check
Company Name _________________
Name on Card ________________________
Address________________________
Address______________________________
Captain’s Phone _________________
Card Number_ ________________________
City __________State_____ Zip_ ____
Exp. Date ____________________________
Email _ ________________________
CVN # ______________________________
This is a three or four digit number printed on the back or front of the credit cards.
Phone _________________________
Signature ____________________________
Submit your form by mail to:
Speedway Children’s Charities / P.O. Box 500 / Hampton, GA 30228
Make checks payable to: Speedway Children’s Charities
For More Information:
Please contact BJ Mathis at 770-946-3980 OR
[email protected]
Register Online:
https://atlanta.speedwaycharities.org/events/
fore_kids_fall_golf_tournament/registration/
Speedway Children’s Charities is a 501(c)(3) non-profit tax exempt organization. Proceeds are tax
deductible to the extent permitted by law. Tax ID # 56-1331429.