Please register me for:  ____ Platinum ____Gold ____Silver ____Team
	Team Captain:
	Address:
	Telephone:
	Email:
	*Apparel Size: Men's ______  Women's ______
	Team Member:
	Address:
	Telephone:
	Email:
	*Apparel Size: Men's ______  Women's ______
	Team Member:
	Address:
	Telephone:
	Email:
	*Apparel Size: Men's ______  Women's ______
	Team Member:
	Address:
	Telephone:
	Email:
	*Apparel Size: Men's ______  Women's ______
	*Apparel for Platinum, Gold and Silver donors
	______ Single Player, assign me to a foursome
	______ Honorary Donor/Hole Sponsor
	______ Flag Waver
	Amount Enclosed: $ ___________________	Please remit by June 1, 2008 to: Kristin Amico Sesselman Leukemia Foundation PO Box 2191 Danvers, MA 01923 (978) 777-3424

Back to Kristin Fund Homepage • Back to Golf Page