Paige Kendra Houston Memorial Scholarship Fundraiser will be held on September 20, 2019 at:
Blackledge Country Club
180 West Street
Hebron, CT 06248
Dinner, music, raffles and great people! PLAYER REGISTRATION FORM
Blackledge Country Club Hebron CT 06248
$125 Contribution Per Player
Pla
yer 1 First_____________________Last___________________Telephone_____________
Address___________________________ Shirt Size Circle One S M L XL XXL # #
Player 2 First_____________________Last___________________Telephone_____________
Address___________________________ Shirt Size Circle One S M L XL XXL # #
Player 3_First____________________Last___________________Telephone_____________
Address___________________________ Shirt Size Circle One S M L XL XXL # #
Player 4 First_____________________Last___________________Telephone_____________
Address___________________________ Shirt Size Circle One S M L XL XXL # #
PAYMENT OPTIONS
BY CHECK: Make Checks Payable to: Paige Houston Memorial Fund
Total Amount Enclosed $________ Check number____ Then send along with this form to
Paige Houston Memorial Fund P.O Box 342- Hebron, CT 06248
REGISTER EARLY
FORWARD THIS REGISTRATION FORM TO ALL WHO WOULD WANT TO ATTEND OR SPONSOR THANK YOU!!!