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2004 REGISTRATION FORM

Sponsorship Type:	Platinum Gold Silver Individual Hole Sponsor ~ Please Choose One ~
Preferred Day:	September 13, 2004 September 14, 2004
Company:
Name:
Address:
City:
State:
Zip Code
Phone:
Fax:
Email:
Are you a Clickitgolf.com member     YES NO
Team Information
Player 1 (Capt.):		Shirt Size	SM MD LG XL XXL XXXL
Player 2:		Shirt Size	SM MD LG XL XXL XXXL
Player 3:		Shirt Size	SM MD LG XL XXL XXXL
Player 4:		Shirt Size	SM MD LG XL XXL XXXL
Payment Type:	Check Cash Visa Mastercard AMEX
Name on Card:
Card Number:
Expiration Date:
Payment - Please make checks payable to Speedways Children's Charities. Mail To:  Speedways Children's Charities  ATTN: Kenny Marion, 5245 Z-Max Blvd, Harrisburg, NC 28075 PH: 704.455.4982   FAX: 704.455.4629

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