Fundraiser for the Marble Church Arts Centre Sponsored by the
Tweed & Area Arts Council
“4 Person Scramble” Sunday June 10 , 2012, Poplars Golf Club, Tweed. Shotgun Start at 11 a.m. $95 per player. ($85 for Poplars members) PRE-Registration recommended. Limited to 144 Spaces. Register today! We would like to encourage you to enter a mixed team this year.

All profits benefit the Marble Church Arts Centre. Please make cheques payable to: Tweed & Area Arts Council. Fill out the form and mail to: Jack Vance Golf Classic c/o Don Herbertson, 92 Stoco Road, R.R.#4 Tweed, Ontario, K0K 3J0. A charitable tax donation receipt will be issued to each participant.


Name: _____________________________________________________________________________________

Address: ___________________________________________________________________________________

City: ____________________________________ Province: _________ Postal Code: _______________

Phone #: ________________________ e-mail: __________________________________________________


PAYMENT ENCLOSED # of people ________ X $95 ($85) = __________________

I would like to make a donation of $ _________ to the Tweed & Area Arts Council

I would like to attend the dinner & reception ONLY (cost $25) ____ X $25 = ______

I would like _____ additional tickets for the dinner & reception $25 = __________

I would like a tax receipt in my name: _______________________________________

We need a tax receipt for each player (Name & Address required below)

Please arrange a foursome for me

I prefer to play with:

1. _________________________________________________________________________________

2. _________________________________________________________________________________

3. ________________________________________________________________________________