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					                                                                            21st World Captive Forum – Golf Tournament Player Information Form
                                                                                                                       January 30, 2012
                                                                                                                 Doral Resort & Spa, Miami, FL
                                                                                                                     Shotgun start: 8:00am
PLAYER INFORMATION (please type or print)

Name: (first)                                                                          (last)                                                                                 _
Address: _________________________________________________________________________________________________________
City: ____________________________________________ State: ___________ Zip: ___________Country:__________________________
Phone: (______) _______________________________________ Fax: (______) ________________________________________________
Email: ______________________________________________Nickname for Badge: ____________________________________________

Handicap:                                            Need to Rent Clubs? ($85/set): Yes                   No           Need to Rent Shoes? ($15): Yes                 No

Teammate requests (if applicable): ____________________________________________________________________________________

TOURNAMENT INFORMATION
Tournament Location:                                                                                     Course:
Doral Golf Resort                                                                                        Red Course
            th
4400 NW 87 Avenue                                                                                        18 holes, 6,101 yards
Miami, Florida 33178                                                                                     Par for course: 70

Registration: begins at 7:00am                                                                           Included in Registration:
Shotgun start: 8:00am                                                                                                Boxed Breakfast and Lunch
                                                                                                                     Bottle of water
Teams will be organized by the planning committee. Please indicate                                                   Sleeve of golf balls
special requests for teammates on the line above or contact us at                                                    Practice balls
info@worldcaptiveforum.com. If you register four players you will all
                                                                                                                     Green fees
be put onto the same team automatically unless otherwise requested.
                                                                                                                     Cart rental

REGISTRATION OPTIONS * only complete if you did not already register online (all fees and prices are listed in US Dollars)

            Golf Tournament - One player ($195.00)                                                                    Golf Tournament - Four players ($780.00)
                                                                                                                      * please complete “player information” section for each player

                                                                     Players must register by January 13, 2012.
Cancellations: Cancellations must be made in writing to the World Captive Forum office. Cancellations must be made on or before Friday, January 13, 2012 in order to receive a refund. Cancellations
received after January 13, 2012 will not receive a refund, but may be transferred to another member of the same company. In the event WCF cancels the program, WCF is not responsible for any airfare,
hotel or other costs incurred by registrants.

PAYMENT INFORMATION * only required if you did not already register online

 Credit card (fill out information below)                                                          Please send an invoice

Name on credit card:                                                                   Type of card:

Billing Address:

CC Number:                                                                Exp Date:                             CV2 Code:



                                The 2012 World Captive Forum Golf Tournament is sponsored by:




                                                            Please mail or fax completed form to:
                                           World Captive Forum | 4248 Park Glen Road, Minneapolis, MN 55416
                                       Ph: 952-928-4659 | Fax: 952-929-1318 | Email: info@worldcaptiveforum.com

				
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