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 cheque, cash, VISA or Mastercard (please choose one below).
We will arrange collection of payment after we receive your information from this email form.