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2005 Kelli Molder Memorial Classic Registration Form
To register (team or individual), print, complete, and mail this form to the address below.

Tee Time Preference: 8 a.m. (or) 1 p.m.
(Actual Tee Time will be determined by order of signup and preference)

Player 1

Name _____________________________

Address ___________________________

_____________________________

Phone _____________ Avg. Score _____

Player 2

Name _____________________________

Address ___________________________

_____________________________

Phone _____________ Avg. Score _____

Player 3

Name _____________________________

Address ___________________________

_____________________________

Phone _____________ Avg. Score _____

Player 4

Name _____________________________

Address ___________________________

_____________________________

Phone _____________ Avg. Score _____

Player / Team Registration
Complete the form above and mail to: Conway K-Life | P.O. Box 1282 | Conway, AR 72033. Please make checks payable to Conway K-Life. All contributions are fully tax-deductible to the maximum extent allowed by law. Tax receipts are issued to individuals and companies from which checks are received. Thank you for your support of K-Life's work with teenagers!