1. 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
Name as it appears on License:
Driver’s License Number: State Issued:  
Sponsor: NAS Oceana Golf Course Point of Contact: Randy Clark
Ph. #:   Event Date: June 22, 2017
100% of Net Proceeds Donated to HR ALA Scholarship and Charity Fund!