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REGISTRATION FORM
THIRD ANNUAL MADISYN KEMP MEMORIAL GOLF TOURNAMENT
September 26, 2008
Meadows Golf Club

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Note: All fields are required for your registration to be accepted. Any partial forms will be discarded.

Player 1 (Captain and primary contact)
Name

Phone

Address

E-Mail


Player 2
Name

Phone

Address

E-Mail


Player 3
Name

Phone

Address

E-Mail


Player 4
Name

Phone

Address

E-Mail

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Please select one:
Eagle Package: $ 600.00 includes four golfers, mulligans, and a tee box sign
Birdie Package: $400.00 includes two golfers, mulligans, and a tee box sign
Par Package: $300.00 includes one golfer, mulligans, and a tee box sign
Foursome: $400.00
Single: $100.00
Tee box sign only: $250.00
I will not be able to play but would like to make a donation.

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Early registration deadline is August 29th. All golfers who are registered and have paid by August 29th will receive a free T-shirt.

To donate or pay registration in advance, make checks payable to FightSMA and mail to:
Karen Self
5024 Longleaf Lane
Birmingham, AL 35242

Please include the team sponsor name and/or the team captain name with the check.

For more information or questions, contact Karen Self at 995-5546 or Patti Kemp at 497-0953.

Note: FightSMA is a 501 (c) corporation. Federal tax ID 54-1610701.

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