BIG HEARTS for little hearts
Golf Tournament (online entry form)

10th annual BIG HEARTS for little hearts Golf Tournament
September 20, 2010 at Topeka Country Club.
Shotgun Start 12 p.m.

Please fill out entry and submit online or print and mail to:
Stormont-Vail Foundation
1500 S.W. 10th Ave., Topeka, KS 66604-1353
with payment by July 30, 2010, to make your team or individual reservation.
As soon as your entry form is received online, you will be invoiced for the total amount.
Please call us at (785) 354-6851 for more information.

Captain's First and Last Name:

E-mail Address:

#1 Player Information: complimentary paid (Check one)

Player's First and Last Name:

Address:

City:

State: Zip:

Phone Number

#2 Player Information: complimentary paid (Check one)

Player's First and Last Name:

Address:

City:

State: Zip:

Phone Number

#3 Player Information: complimentary paid (Check one)

Player's First and Last Name:

Address:

City:

State: Zip:

Phone Number

#4 Player Information: complimentary paid (Check one)

Player's First and Last Name:

Address:

City:

State: Zip:

Phone Number

Paid Players @ $300 = $ (You will be invoiced)

Number of players attending dinner

I will attend dinner (no extra charge). Additional dinner guest(s) @ $25 each (You will be invoiced)

Hole Sponsorship – $1,500
Register two complementary players on this form. (You will be invoiced)

We will not be able to attend this important event. Please accept a gift to the Children's Endowment Fund $ (You will be invoiced)