** REGISTRATION **
June 14, 2011
22nd Annual Golf Tournament
Loch Lloyd Country Club

Check-in begins at 10:00 am ** Shot Gun Start at 12 noon
Lunch provided by Applebee's 11:00 am** Dinner & awards at the Country Club immediately following the tournament

 


You may enter up to four players (foursome) per registration.
Please complete all information to ensure proper entry into the tournament.

Name (Player 1):
You forgot to enter your name

E-mail Address:

Your email address is required for registration.

Address:
Please enter your address.

City, State, Zip:
Please enter your city state and zip code.

Daytime Phone Number:
Please enter your phone number.

Number of Entry Fees:
/ / @ $300 per person

Payment Type:

Check Payments: See mailing instructions below

Credit Card Number:
This card number appears to be incorrect. Please double check the number and try again.
*** Please verify your typed credit card number for accuracy ***

Name as it Appears on the Card:

Please enter your name.

Expiration Date :

Please enter your expiration date.

 

  

ADDITIONAL PLAYER INFORMATION

Name (Player 2):

E-mail Address:

Address:

City, State, Zip:

Daytime Phone Number:

   

Name (Player 3):

E-mail Address:

Address:

City, State, Zip:

Daytime Phone Number:

   

Name (Player 4):

E-mail Address:

Address:

City, State, Zip:

Daytime Phone Number:

COMMENTS

Comments:

Sponsorships Available. Contact Joyce Eacock, Director Special Events 913-706-5972 for information.

Check Payments: Mail along with completed registration form to Love Fund, 3030 Summit St., Kansas City MO 64108