Social Security #: _____________________
Email Address ________________________
Entry Fee $200.00
Payment Type: ____Check ____Money Order ____C.C. *
*Credit Card Information (Visa, Mastercard, or American Express):
Name on Account: ___________________
Type of Card: _______________________
Card Account #: _____________________
Expiration Date: _____________
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Pro Entry
Britton Country Club
10920 424th Ave
Britton, SD 57430
Contact:
Mavis Ochsner, Club Manager
605 448-2512
