Registration

2009 Golf Registration
Please click on the Submit button to submit the form details.

* indicates required fields

*First and Last Name:

*Company Name:

*Street Address:

*City:

*Postal Code:

*Telephone Number:

*Email Address:

*How did you hear about this event?:

*I wish to register for this event:

Golf and Dinner $125 per person
Dinner only $55 per person

*Will you be bringing a guest?:

Yes
No

If yes, how many?:

Please enter your guest(s) names:

*Form of Payment:

Visa
Cheque (payable to EMBERS)

If paying by credit card, please enter card number:

Name on Credit Card:

Expiration Date:

Cheque number:

Once you submit this form, please return to the previous page for individual and team golf sign up.

Suite 209 - 124 East Pender Street, Vancouver, B.C. V6A 1T3
Phone: 604-692-0781 Fax: 604-692-0780
Email: info@embersvancouver.com