Wednesday September 11th - Benefit GOLF and DINNER to support our guide dog, Tippi

ROTARY CLUB AMSTERDAM INTERNATIONAL

REGISTRATION

Benefit Golf for our guide dog TIPPI

WEDNESDAY SEPTEMBER 11

Old Course Loenen (OCL)

Rijksstraatweg 171 / 3632 AC Loenen aan de Vecht/ 0294-237600

www.oldcourseloenen.nl

(Please fill in one registration form per person)

Please return this form to lia.vandenberg@planet.nl with cc to jrmarmitage@hotmail.com and m.e.vanbodengraven@wxs.nl

Last Name __________________________________________________________________________

First Name ____________________________________

Home course (if applicable)---------------------------------------Handicap (exact /minimum GVB)___ __

Email address ________________________________________________

Telephone mobile _______________________________

I am invited by _________________________________________________________________

I will (please check the applicable box)

O Participate in golf tournament (€ 110)

O Participate in clinic (€ 110)

O Drinks and dinner only (€55)

o

Unfortunately, this outing does not fit in my agenda. However, I do wish to support our guide dog TIPPI and will transfer a donation or provide a prize for the raffle and/or silent auction.

Upon confirmation I will directly transfer the required amount into account number NL26ABNA0541525581 at ABN AMRO Bank in Amsterdam, in favour of RCAI, reference : “Golf for guide dog TIPPIE” and please also mention your last name.

If you are not able to attend but would like to contribute, please make your donation with the reference “Golf No / support Guide Dog TIPPI YES”

Questions / comment/-------------------------------------------------------------------------------

Scan0001.jpgThank you so much for your support!