Please print this page and mail with payment to:

Jim O'Grady
Petaluma Valley Rotary
1485 McGregor Ave
Petaluma, CA 94954

$85 for Single Players or $300 for a Foursome (includes Reception)

Player Name: ___________________________________ Phone: __________________________

Player Name: ___________________________________ Phone: __________________________

Player Name: ___________________________________ Phone: __________________________

Player Name: ___________________________________ Phone: __________________________

Reception Only (view the Million Dollar Shot and enjoy the Food and Fun!) $25 per person

 Attendee Name: _________________________ Attendee Name: ___________________________

Attendee Name: _________________________ Attendee Name: ___________________________

Total Amount Enclosed:_____________

Please make checks payable to: Petaluma Valley Rotary OR Credit Card:

CC #__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ EXP __ __/__ __

Name on Card : ______________________________________

For More Information Call Jim O’Grady at 773.0783   ---   

Return this Form to Jim: 1485 McGregor Ave. Petaluma, CA 94954