The 16th Annual DEACON LAWRENCE E. KELLEY, SR. Memorial Golf Classic

Player 1 Entry Fee

Confirm Entry - $125.00

Mulligans for Player 1?

1 - $5.00
2 - $10.00
3 - $15.00
4 - $20.00

Team Name (Optional)

Player 1 Name (Required) *

First

Last

Player 1 E-mail (Required) *

Player 1 Phone Number (Required) *

Player 1 Address (Optional)

Address Line 1

City

State

Zip Code

Player 2 Entry Fee

Confirm Entry - $125.00

Mulligans for Player 2?

1 - $5.00
2 - $10.00
3 - $15.00
4 - $20.00

Player 2 Name (Required) *

First

Last

Player 2 E-mail (Required) *

Player 2 Phone Number (Required) *

Player 2 Address (Optional)

Address Line 1

City

State

Zip Code

Player 3 Entry Fee

Confirm Entry - $125.00

Mulligans for Player 3?

1 - $5.00
2 - $10.00
3 - $15.00
4 - $20.00

Player 3 Name (Required) *

First

Last

Player 3 E-mail (Required) *

Player 3 Phone Number (Required) *

Player 3 Address (Optional)

Address Line 1

City

State

Zip Code

Player 4 Entry Fee

Confirm Entry - $125.00

Mulligans for Player 4?

1 - $5.00
2 - $10.00
3 - $15.00
4 - $20.00

Player 4 Name (Required) *

First

Last

Player 4 E-mail (Required) *

Player 4 Phone Number (Required) *

Player 4 Address (Optional)

Address Line 1

City

State

Zip Code

Tee Box Sponsor

Confirm Sponsorship - $100.00

Name/Business (Required for Tee Box Sponsor) *

Name of Individual or Business for sign

Other Donation Amount (Optional)

Donator Name

Total

$0.00

Mail Checks Payable to:
Miracle Temple Ministries, Inc.
C/O Golf Tournament
P.O. Box 25174
Memphis, TN. 38125
All proceeds benefit Miracle Temple Ministries 501c (3) charitable corporations. Your contribution is tax-deductible. Please check with your tax advisor

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