Register Online

Please enter your name and company as you want them to appear on your name tag.
First Name:
Last Name:
Company:
Title:
Business Phone:
Business Fax:
Business Address: * Required Field
City: * Required Field
State: * Required Field
Zip Code: * Required Field
Country:
E-Mail: * Required Field       (Registration confirmation will be sent to this address)
Assistant's First Name:
Assistant's Last Name:
Assistant's Business Phone:
Assistant's Fax:
Assistant's E-Mail:                                     (Registration confirmation will be sent to this address)
Emergency Contact Name:
Emergency Phone Number:
Participation Level:

Monday Course Preference:

Corporate Level participants only, please choose below. We will try to accommodate all requests.

Harbor Shores

Index & Home Course Handicap                            (Sunday Players Only)

Comments/Special Requests:
 

Please send your donation check no later than Friday, July 20, 2012.

Checks Payable To:
   Boys & Girls Club of Benton Harbor

Mail Check In Care Of:
   Whirlpool Corporation
   ATTN: Mari Hoffmann
   2000 M63 North – MD 3108
   Benton Harbor, MI 49022

Wire Transfer:
   Please Contact Mari Hoffmann at (269) 923-6690 or (269) 208-3700

   Credit Cards: We cannot accept credit cards at this time.

Download W-9 Form

Questions? Call Mari Hoffmann at (269) 923-6690 or (269) 208-3700

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