14th Annual Henry County F.O.P. Golf Tournament

Sponsored by Henry County FOP Lodge 206

Print and Complete This Form and Mail With Payment to Address Below

Friday June 24, 2005 at Midland Country Club, Kewanee, IL

12:00 Noon Shotgun Start (Sign-in starts at 11:00 AM)

Raffe for a Smokey Gold and Vivid Black Harley Davidson VRSCA V-ROD Motorcycle!
$70.00 / person $280 / 4 person team

Four person preferred ball format

Team Captain:

Name: ____________________________

Address: ____________________________

Phone: ____________________________

Player #2: ____________________________

Player #3: ____________________________

Player #4: ____________________________

 Your entry fee includes18 holes of golf, cart, drinks on the course, and a meal after the end of play.

Dress code: NO T-SHIRTS / NO JEANS

Print and complete this form, enclose payment, and mail to:

Henry County FOP Lodge 206
PO Box 74
Cambridge, IL 61238

Player sub-total (at $70 each) = $_________

Total Amount Enclosed: $ __________

Raffle tickets are available from any Lodge 206 Member, or contact Chad below. Only 500 tickets will be sold!

For further info call:

 Chad Baze: (309) 852-2746
Cell: (309) 883-0104
Work: (309) 937-3940