GEORGIA MOOSE ASSOCIATION
STATE GOLF TOURNAMENT
REGISTRATION FORM
TEAM NAME: ____________________________________________________
TEAM CAPTAIN: ____________________________________________________
LODGE NAME: ____________________________________________________
PLAYERS NAME - AMT. PAID
1.
________________________________________ $__________
2.
________________________________________ $__________
3.
________________________________________ $__________
4.
________________________________________ $__________
TOTAL PAYMENT $125.00 PER PLAYER __________
Make checks
payable to Henry County Moose Lodge GOLF ASSOC.
PO BOX 354 MCDONOUGH GA,30253
NO ENTRIES ACCEPTED AFTER MAY 25TH, 2013
I hereby certify
that the named players are members of the lodge specified above and are in good standings. (Letter attached if a player is
not from specified lodge.)
Lodge Administrator
_________________________________________
_________________________________________
Date Signed
PLEASE LIST YOUR FAVORITE
ADULT BEVERAGE____________________ WE WILL TRY TO ACCOMADATE YOUR REQUEST