Please fax or mail your registration with payment by August 29, 2008 to:

Alicia Braccia
CHLA - Providence Academy
1525 South Alafaya Trail, Suite 101
Orlando, FL  32828
Fax #: 407-382-5637


Providence Academy Golf Tournament Registration Form


Name ___________________________________
Address _________________________________
_________________________________________
City ____________ State _____ Zip _________
Phone ___________________________________
E-mail: __________________________________

____   Individual Golfer   $130
____   Foursome                $500

I want to participate as a :
____  Platinum Sponsor    $1,000
____  Gold Sponsor        $750
____  Silver Sponsor      $600
____  Bronze Sponsor      $350
____  GPS Hole Sponsor    $125
____  Lunch Sponsor       $750
____  Donation $ _______ for the school
____  Donation - Prizes

Enclosed is my check for $ ____________
(Payable to: Providence Academy)

Charge my:   _____Visa  ____ Master Card    _____ Discover

Name __________________________________
(As it appears on the card)
Account#: _______________________________
Expiration Date: ___________ Code: ________

Signature: _______________________________    

Hurry!  Registration ends  August 29th