RSM Golf Scramble Registration Form 2016_Long

Annual RSM Golf Scramble

The Hackler Course at Coastal Carolina University

12:30 pm Shotgun Start, Friday, April 15, 2016

All proceeds will go to the RSM Scholarship fund.

Check-in at Hackler Golf Course, 107 Citadel Dr, Conway, SC 29526

Registration Form Player 1

Player 2

Player 3

Player 4

Name _______________________________________________________________________________

Address _____________________________________________________________________________

City ___________________________ State ______________ Zip ______________________________

Telephone _____________________ Email ________________________________________________

Form of Payment: □ Credit Card □ Debit Card □ Cash □ Check □ Pay at the Event

Card Type: □ MasterCard □ VISA □ AMEX

Name on Card: ________________________________________________________________________________

Card Number: _____________________________________ CSC code: __________ Expiration Date: __________

Dustin Thorn, Ph.D. 105 Independence Drive, Williams-Brice Bldg., 151A

Conway, SC 29526 dthorn@coastal.edu (843) 349-2510

* Please make all checks payable to “Coastal Education Foundation”

Entry Fees: Single Team of 4 Total Early Bird (Applies until March 25th) $55 $185 $ ______________

CCU ID# __________ (Discount to all CCU IDs) $60 200 $ ______________

Regular Price $70 $240 $ ______________

Mulligans: $10/each 3 for $20 $ ______________

Donations (If you are unable to participate and still want to make a donation) $ ______________

Total $ ______________

* Included in the entry fee: one round of golf at The Hackler Course, the opportunity to participate in the Silent Auction, games along the way, and complimentary SWAG bag.

All proceeds go towards the RSM Scholarship Fund