AH BLANK GOLF COURSE 808 COUNTY LINE ROAD, DES MOINES, IOWA 50315
CLUBHOUSE PH # 515-285-0864 TOURNAMENT DIRECTOR RON BROOKS & JEFF CHIODO

NAME: ____________________________________________   PHONE #___________________________________

EMAIL: __________________________________________________  CELL #_______________________________

ADDRESS: __________________________________________________________________ ZIP________________

PAYMENT: CHECK / CASH / CREDIT CARD

ENTRY FEE $45.00 INCLUDES GREEN FEE & PRIZE FUND
 DEADLINE MUST BE PAID BY AUGUST 23, 2008 BY 1:00 PM