Mike Pollom Memorial Charity Golf Tournament

The 11th Annual Charity Golf Tournament

Monday, April 16, 2012

Rancho Las Palmas

Shotgun Start - 12:30 pm

March 15th is the deadline to sign up.  Please sign up as soon as possible - the field is limited to 144 players!

REGISTRATION FORM

Names of “dinner only” guests: _________________________________

$600 per foursome/$150 individual/$30 dinner only.

              Golf Fees $83 tax deductible – donations, hole sponsorship 100% (tax ID #95-4725924)

1. Checks payable to the Desert Community Foundation, memo:   

                                                          The Mike Pollom Scholarship Fund

2.  Credit Card Charge:     Amount:  $____________________ 

     Card Type:___________Card #:_____________________  (Master Card/Visa only)

      Expiration Date:______ Security Code:______ Name on Card:_______________

      Signature:______________________________________

Print this form, complete it and send form and payment to:

Mrs. Karen Myers, Financial Chairwoman

115 Don Quixote Drive

Rancho Mirage, CA 92270