p layer One

Player Name
Company
Address
City		PC
Phone Number		Fax
Cell		Email

p layer Two

Player Name
Company
Address
City		PC
Phone Number		Fax
Cell		Email

p layer Three

Player Name
Company
Address
City		PC
Phone Number		Fax
Cell		Email

p layer Four

Player Name
Company
Address
City		PC
Phone Number		Fax
Cell		Email

you can provide your own fourth player, instead of playing with a surprise celebrity chosen by Richard Brodeur - just indicate your desire to do so on this form. Tournament play will feature teams of four in a shotgun format.
We welcome your payment by VISA or Mastercard (please choose one below).
We will arrange collection of payment after we receive your information from this email form.