Mail form and check to:       
Rose Clemensen
2608 E. Standish Avenue
Anaheim, CA   92806-4319
info@paymentconference.com
Contact Information:
714-774-4171  Office  
714-743-0031  Cell
714-776-0400  Fax
Contact Information
Company name:
 $80 Registration
Includes greens fee, cart,
boxed lunch & beverage
Company contact name:
$20 Club Rental
(optional)
Contact phone number:
Handicap
(New golfer list N/A)
 Club Rental
(Check if needed)
Name of Golfer
1.
2.
3.
4.
5.
6.
Teams are assigned by handicap.  Golfers will be notified 1 week prior to conference of information.  
Note:  List N/A for handicap if new golfer.  
Total Amount Due
Total Amount Due for Golfers  
($80 each):
Total # Club Rental
$20 each:
Golf Grand Total Due $:
Record total amount due on this form and on your Registration form.  
Note:  Depress submit button below when completed.
Cancellation Policy:
100% refund provided until August 1
50% refund provided until August 15
No refund after September 1
A $75 processing fee will be applied to all cancellations.

Change Policy:
An initial change fee will be waived.
Each additional change will incur an administration fee of $25.

Invoices will be sent for all administrative fees and will be subject to a 5% charge each month until
paid in full.  
or click "Submit" below, to send electronically and