LT Jim Curran Memorial Golf Classic Registration

Name____________________________________________________________

Company_________________________________________________________

Address__________________________________________________________

City______________________________________________________________

State_____________________________________________________________

Phone____________________________________________________________

Email_____________________________________________________________

Golf package and overnight accommodations        $250 X ______ =___________

Sponsorship Fees                                                 $_____X______ = __________

                 Total = ___________           

Golfers Names:

1____________________________________________________________________

2_____________________________________________________________________

3______________________________________________________________________

4______________________________________________________________________

Please make all checks payable to:
The NY Firefighters Burn Center Foundation

Send this form and payment to:

The NYFF Burn Center Foundation
c/o Gwen Curran
16 Revilo Road
Bayville, NY  11709

For info:
516-628-8240
curran11@optonline.net
ww.nyffburncenter.com