2007 Golf Privilege Card Order Form
Print,
fill out completely and Mail to: American Lung Association of West
Virginia
ATTN: Deb Qualls
(Please
print)
Check one please. Send Golf Card to ____Charge Card
Holder ____ each individual.
Golf Privilege Card
#1:
Name
_______________________________________________________________________________
State ______ Zip __________
Phone ____________Email ____________________________________
Golf Privilege Card #2
Name
_______________________________________________________________________________
State ______ Zip
__________ Phone ____________Email ____________________________________
CARD PRICE: $45.00 Prior to December 31, 2006
PAYMENT METHODS:
o Enclosed is my check for $ ________
for ______ card(s)
Make checks payable to:
ALAWV (American Lung Association of West Virginia)
o Charge my
credit card $ ________ for ________ card(s) o VISA o MASTERCARD o DISCOVER
Charge Card Holder:
Name
_______________________________________________________________________________
State ______ Zip __________
Phone ____________Email ____________________________________
CARD # __________ -
__________ - __________ - __________ ( security
code _______)EXP. DATE _______________
SIGNATURE ________________________________________
GOLF PRIVILEGE CARD
GUIDELINES
I understand that course management reserves the right to
refuse play to card holders who do not abide by course regulations. I
understand that I am allowed one card only. The card is non-transferable
and is only to be used by the card holder. I understand I may be required to
show identification at any participating golf course if requested by golf
course staff. I understand if my card is misplaced, lost, or stolen, the
American Lung Association IS NOT RESPONSIBLE for replacing it.