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, Tweed & Area Arts Council, Box 359, Tweed, Ontario, K0K 3J0. A $50.00 charitable tax donation receipt will be issued to each participant.

Name: _____________________________________________________________________________________

Address: ___________________________________________________________________________________

City: ____________________________________ Province: _________ Postal Code: _______________

Phone #: ________________________ e-mail: __________________________________________________

PAYMENT ENCLOSED # of people ________ X $100 = __________________

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. ________________________________________________________________________________