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Main Contact Name_____________________________________
 
 
 
 
 
 
Address_______________________________________________
 
 
 
 
 
 
City, State, Zip________________________________________
 
 
 
 
 
 
Phone________________________________________________
 
 
 
 
 
 
Email ________________________________________________
 
 
 
 
 
 
Package (circle one)
1. Single Golf and Dinner                                       $100
2. Team of 4 Golf, Dinner and hole sponsorship        $450
3. Hole Sponsorship only                                        $100
4. Dinner Only (PRE-REGISTRATION REQUIRED)        $ 20
     (Please list names of those attending Dinner Only)
      ____________________________________________
      ____________________________________________
                                                                          
                                                          Total :  $_______    
Checks payable to:  Dan Dowson Benefit
Return completed form and payment to:
Dan Dowson Golf Benefit
2506 W. 10th Avenue
Indianola, IA 50125
     
Registration Deadline: June 1, 2010
    
Please list players names & ALL email addresses below:
(limited to ages 18 & older)
________________________________________  Email: _________________
________________________________________  Email: _________________
________________________________________  Email: _________________
________________________________________  Email: _________________


A limited number of Dobbers Up Special Edition caps are available by PRE-ORDER ONLY.
Please see "Order Form" for additional information.  You may send registration
and order forms together.