Registration for 2023 Golf Tournament

Please enter information on this form to register and make payment for 2023 Golf Tournament.

Sponsorship/Registration *

First Name *

Last Name *

Organization

Address *

Address2

City *

State *

Zip *

Country *

Phone *

Email *

Legend 70+ *

Golfer 1 Name *

Golfer 1 Address *

Golfer 1 Email *

Golfer 1 Phone *

Golfer 1 Handicap *

Golfer 1 Legend 70+ *

Golfer 2 Name *

Golfer 2 Address *

Golfer 2 Email *

Golfer 2 Phone *

Golfer 2 Handicap *

Golfer 2 Legend 70+ *

Golfer 3 Name *

Golfer 3 Address *

Golfer 3 Email *

Golfer 3 Handicap *

Golfer 3 Legend 70+ *

Golfer 4 Name *

Golfer 4 Address *

Golfer 4 Phone *

Golfer 4 Handicap *

Golfer 4 Legend 70+ *

What would you like your tee sign to say? *

Handicap *

Total Amount

Payment method

Credit Card

Billing Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

Verification code*

Connecticut Breast Health Initiative

Registration for 2023 Golf Tournament