Golf and Luau Registration Base Access Required Information Golf & Luau Industry $60 Resale $60 Luau Only Industry $15 Resale $15 2017 Purina & CAPT Ollie Bates HR ALA Luau & Golf Golf and Luau Registration Name:__________________ # of Guests:____ Address:______________________________ Total Amount Remitted:_______________ Do you have a 4-Some? We’ll need those Registrant Names ________________ Please Remit Payment to: HR ALA c/o Paul Wehner, MDV 1133 Kingwood Ave Norfolk, VA 23502 --------------------------------------------------------------------------------------------------------------- Base Access Required Information   This form must be filled out entirely for each attendee.   Please forward form to Mr. Paul Wehner, MDV 757- 858-9396 Paul.Wehner@spartannash.comm Name as it appears on License: Driver’s License Number: State Issued:   Sponsor: NAS Oceana Golf Course Point of Contact: Randy Clark Ph. #: 757.433.2866   Event Date: June 22, 2017 100% of Net Proceeds Donated to HR ALA Scholarship and Charity Fund!