Please include your full name and mailing address for tax receipt purposes
Additional Team Member Names (if applicable)
Payment Method
Name on Card Authorized Payment Amount $
Card Number Expiration: Month: Year:
Cheque
Please make cheque payable to: Yuri Mutiger Memorial Fund and mail it to:
Golf4Yuri Memorial Tournament Attention: Jorun Rucels 4 Donwoods Court Brampton, Ontario L6P 1C5 Telephone: 905-794-0026, e-mail: jorun@rogers.com