St. Joseph's Center Registration Form



Carl Jones
Memorial
Golf Classic




Monday, September 11, 2017


      

Glen Oak Country Club


Secure Online Registration Form


Please note that fields with an asterisk (*) are required.

                      
   ONE GOLFER $250
 TWO GOLFERS $500
 THREE GOLFERS $750
 FOURSOME $1,000
 

Please note that your donation is not fully deductible under I.R.S. regulations. If you request, a statement will be provided to you following the tournament advising you what portion is tax deductible.

*First Name:  *Last Name: 
*Address 1:  Address 2: 
*City:  *State: 
*Zip Code:  *E-mail: 
*Daytime Phone #:  Evening Phone #: 

Company/Organization Name: 

Members of my foursome will be:                                                       

Name:  
Name:  
Name:  

                           *I/We will be attending the dinner?    Number attending 



*Credit Card Type: 
Credit Card #: 
*Exp. Date:  /

Special Requests:


After ensuring that all of the information above is correct,
please click the Submit Form Now button ONLY ONCE.
Multiple clicks of the Submit button will result in duplicate charges to your account.
An email confirmation will be sent to the email address you provided.


 

  
Saint Joseph's Center
2010 Adams Avenue • Scranton, Pennsylvania 18509 • Phone: 570-963-1260 • Fax: 570-342-6080
Send us an e-mailwww.stjosephscenter.org


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