Enter Name, Agency, and E-mail address of Each Player on the space provided below. We will be sending all

notification of the upcoming events via email, so email address is necessary!

Team Captain______________________________________________________________

Player 2 _______________________________________________________________

Player 3 _______________________________________________________________

Player 4 _______________________________________________________________

Payment Enclosed: ____________X_____$60_______ =___________________Amount Paid

ISLAND GREEN GOLF COURSE

2011 Law Enforcement Charity Golf Scramble

September 2, 2011

8:00 AM Shotgun Start

Four Person Scramble Format

$60/player

Make Payment Payable to: Springfield Police Sergeant’s League

Send to: IRS-CI, 2937 S. Claremont, Springfield, MO 65804

For additional information

Contact: Don Puckett (417) 353-3873

Donald.Puckett@ci.irs.gov

Contest and prize on every hole

Includes 18 holes of golf with cart and meal

Register as a team - captain must be in law enforcement related field (fire, emt, prosecutor, retired, etc.)

Deadline for Registration – August 20th (teams registered and paid by Aug. 1st entered in special drawing)---------------------------------------------------------------------------------------------------------------------

Proceeds Benefit:

Smart Moves program, a

comprehensive drug prevention

program, developed by the Boys

& Girls Clubs of America

Missouri Law Enforcement

Funeral Assistance Team