Eureka Golf Outing Registration

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Email address *

First name *

Last name *

Address 1

City

State

ZIP Code

Cell Phone Number

Are you registering as an individual golfer, a foursome or for dinner only? *

Individual Registration - $150 Foursome - $550 Dinner Only - $30

Golfer #2?

Golfer #3?

Golfer #4

* required field