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Golf Entry Form - Please type normally, making sure to fill in required boxes (*)

Contact Name *
Address * City *
State * Zip *
Best Phone * (e.g. 4025961616) 2nd Phone (e.g. 4025961616)
Email *

Listed below are the golfer that will be attending: (Single Golfers Welcome)

Name (1) Name (2)
Name (3) Name (4)

Golfer's Donation - # of Golfers x $75.00:
$ (e.g. 300)
Golfer's Fun Package - # of Golfers x $25.00:
$ (e.g. 100)
I would also like to make a donation:
$
Total Amount of Check: *
 $

I will submit the following items for Door Prizes (Have someone call to pick up)




Mary Hulbert
Director
402.429.8895
mhulbert@neb.rr.com
Nebraska State Soccer
10700 Sapp Brothers Drive - Suite B
Omaha, Nebraska 68138
(L) 402.596.1616
(T) 800.909.4458
Additional Information
will be mailed once
you register!