Golfer Registration Golfer Registration "*" indicates required fields Name* First Email* CompanyPhone*Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Register and pay as a foursome, twosome or as an individual, listing those in your twosome or foursome. Singles and twosomes will be grouped with non-foursome players when possible. If pairings are not possible, golfers may opt-out.CaptainPlayer 2Player 3Player 4Please reserve the number of breakfast burritos below for me or my team. I agree to pay $6.00 the day of, for each burrito.My team will play in the following division* Open Division First Responders Division (at least two players must be active or retired first responders) Payment Method* Pay online Pay with Cash/Check Pay* Single Golfer, $115 Twosome, $230 Foursome, $460 Pay* Single Golfer, $115 Twosome, $230 Foursome, $460 Total Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.