Name:_____________________________________

Address:____________________________________

___________________________________________

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Golf & Banquet $225.00   X_________                                                             

Other golfers in your foursome (if known)

_____________________________________

_____________________________________

_____________________________________

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Banquet only  $100.00 X_________                                                                Total___________

Guests:________________________________________

______________________________________________

______________________________________________

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Hole Sponsorship:( Contact Ken Belz to coordinate placement and graphics)

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Tee Box   $125.00  _________

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Greens Flag $175.00_________ 

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                   Send to : Roger Belz 11 Lakeside Drive. Lake Ronkonkoma, NY. 11779