29th Annual Shrine Open Golf Tournament
Four Person Scramble -- September 18, 2017

Sponsored by: Sesostris Shrine
Wilderness Ridge Golf Club, 1800 Wilderness Woods Place, Lincoln, NE – 
Registration at 10:30 am - Shotgun start at 12:00 PM

TEAM ENTRY FORM

 $125 per person entry fee includes:
(Cart, 18 Flag Prizes –1st, 2nd, & 3rd Places in 3 Flights 
 Putting Contest, Goodie Bag
Lunch at the course, and Steak Dinner at Shrine Center)
Silent Auction items available for bid at Shrine Center

Extra banquet tickets available at $15 each (Spouse and/or friends welcome to attend the banquet)
(Please Print All Information)
	
	Name ___________________________________Email address:______________________________________ 

1.	Address________________________________________________________Phone______________________

	City, State, Zip _________________________________________________# of Extra Banquet tkts________

	Name ___________________________________Email address:_____________________________________ 

2.	Address________________________________________________________Phone______________________

	City, State, Zip _________________________________________________# of Extra Banquet tkts________

	Name ___________________________________Email address:_____________________________________ 

3.	Address________________________________________________________Phone______________________

	City, State, Zip _________________________________________________# of Extra Banquet tkts________

	Name __________________________________ Email address:______________________________________ 

4.	Address________________________________________________________Phone______________________

	City, State, Zip _________________________________________________# of Extra Banquet tkts________

ENTRY DEADLINE – SEPTEMBER 11, 2017
Master Card, Visa, Discover or Make Checks Payable to:  
Sesostris Shrine, 1050 Saltillo Road, Roca NE 68430
Call: 402‑474‑6890, ** Fax: 402-474-6918, ** 
E-Mail: maryann.townsend@sesostrisshrine.org
Net proceeds from this tournament are for the benefit of Sesostris Shrine.
Payments are not deductible as charitable contributions.