TEAM/PLAYER REGISTRATION FORM
[ ] Yes! I/We wish to participate in SafeHaven’s 15th Annual Stars ‘N Stripes Golf Scramble
starting at 8:00am on July 1, 2017 at Golf Club of Oregon. All proceeds to benefit the animals of
SafeHaven Humane Society.
Player #1*
Player #2
Address
Address
City | State | Zip
City | State | Zip
Email
Email
Phone #
Phone #
Handicap (if known) __________________________ Handicap (if known) ___________________________
* Individual players may register and will be paired the morning of the event according to handicap (if provided).
[ ]
I am registering as an individual player x $75 = $________
[ ]
I/We are registering as a 2-person team x $140 = $________
[ ]
I/We would like a golf cart
Payment Options:
[ ] A check made payable to the SafeHaven Humane Society is enclosed
[ ] Credit Card (name on card must match player 1 and/or player 2)
Name (as it appears on the card): ____________________________________________________
Card #_______________________________________ Exp. Date ___________ CVV # ________
Please Circle: Visa – Mastercard
Signature: ______________________________________________________________________
Please mail or fax this form to:
SafeHaven Humane Society
Attn: Brittany Milani/Ashley Barker
32220 Old Hwy 34 Tangent, OR 97389
541.926.2924 (phone) 541.926.3642 (fax)
SafeHaven Humane Society is a not-for-profit 501(c)(3) corporation; Tax ID# 93-0676661
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