Illinois Agriculture in the Classroom Golf Outing

Thursday, August 5, 2010

Wolf Creek Golf Club & Elks Country Club, Pontiac, IL

Please note:  This form is to be used for on-line credit card payments only.  The following are accepted:  MasterCard, Visa, Discover.  If you plan to pay by check, please click here for the mail-in registration form.

*=Required
Prefix: 
Name as it appears on credit card if different than name of registrant:  
First Name:*           Middle Initial: 
Last Name:*                    Suffix: 
Address:*                 
City:*                 
State:*                    Zip:*                 
County*:                
Organization:    

                 Please check here if your organization is paying the participant registration fee.
Email:*                  (additional information and notifications will be sent by email)
Daytime Phone*:                 
Evening Phone: 
Golf Course Preference:*           Elks   Wolf Creek
Golf Course Choice not Guaranteed  
I'm participating as a member of a foursome:*   Yes   No
Check here if you do not know the other members of your foursome.
 Check here if you are entering as an individual and would like to be assigned to a foursome.
Check here if you are paying for your own registration.

If you are participating as a member of a foursome, please list the names of the other golfers in the fields below.  Please select the box next to the name of each player that your are paying for at this time.
Paying for Last Name First Name