Dates:	Monday, July 27, 2009 Register by July 6, 2009
Times:	10:30am golf registration with box lunch 12pm golf, shot-gun start (scramble format) 5:30pm cookout reception
Location:	University Ridge Golf Course 9002 County Road PD Verona, WI Tournament will be held rain or shine
Contact:	Jennifer Hust (608) 263-0160

1. Complete the form below.
2. Print out this page.
3. Mail form to:
   Jennifer Hust
   Heads Up Golf Outing
   UW Carbone Cancer Center
   600 Highland Avenue, K4/658
   Madison, WI 53792-6164

Name:
Organization:
Address:
City, State, Zip:
Phone:
Email
Standard fees:

	Golf Foursome (lunch and dinner included) @ $800 each ($300 tax deductible)	$
	Single Golfer (lunch and dinner included) @ $200 each ($75 tax deductible)	$
	Dinner only @ $25 each ($25 tax deductible)	$
Head and neck cancer patients & family members:
	Golf Foursome (lunch and dinner included) @ $200 each	$
	Single Golfer (lunch and dinner included) @ $50 each	$
	Dinner only @ $25 each	$
Donation: I/we would like to contribute toward head and neck cancer research at the UW Carbone Cancer Center.		$
Regrets: I/we are unable to attend, but would like to contribute toward head and neck cancer research at the UW Carbone Cancer Center.		$
	Total enclosed:	$

Payment:
Please make checks payable: UWF - Head and Neck Cancer Research.

Or pay with Visa or Mastercard

Account number
Cardholder's name
Cardholder's signature

Participants
Golfer #1 Name
Address
City, State, Zip
Golfer #2 Name
Address
City, State, Zip
Golfer #3 Name
Address
City, State, Zip
Golfer #4 Name
Address
City, State, Zip
Participating In Honor of:

Questions?
Contact Jennifer Hust (608) 263-0160.

Proceeds will benefit head and neck cancer research and services at the UW Carbone Cancer Center.