Monday, June 19, 2017 (1:00 p.m. shotgun start)
Weissinger Hills Golf Course 2240 Mt. Eden Road Shelbyville, KY 40065
Registration begins at 11:45 p.m.
Spend a day (and some dollars) on the course for a charitable cause! The Middletown Lions Club
is the sponsor, but its people and companies like you that help to make this event possible. The monies
raised from this event are used locally to help families and individuals in need. List of Organizations on back. We also respond to national disasters through the Lions Club Districts. Join us for what promises to be a fun-filed day on the course.
What: This is a 4 person Scramble (Printed rules-the scramble is flighted-INDIVIDUALS welcome)
Entry Fee: $70 Per Person/$280 Per Team (This price includes a box lunch, 1 soft drink or tea, a putt
stretcher and a goodie bag filled with goodies and a $5 gift card)
Extras: Putting Contest ($5.00 for 3 Balls), Raffle Basket (5 for $5 or 15 for $10), Silent Auction Gift Card Basket
(Bring Extra Cash or Check to participate in these events)
4 Closest to the hole
Longest Putt
Women & Men’s Longest Drive
Raffle Gift Card Basket
Silent Auction Gift Card Basket
Putting Contest
MLC Golf Scramble Registration
Contact Person:_______________________________________________________________________________
Phone Number:_______________________ Email Address:___________________________________________
Organizational Name (if applicable): ______________________________________________________________
O Individual Registration ($70) O Team Registration ($280)
Player # 1___________________________________________ Handicap-__________________
Player # 2___________________________________________ Handicap-__________________
Player # 3___________________________________________ Handicap-__________________
Player # 4___________________________________________ Handicap-__________________
O I am unable to participate, but would like to make a donation of: ___________________
Lion Contact:__________________________ Phone Number:_____________________________
Please contact us or return this form along with a check made payable to the Middletown Lions Club.
Mail /Drop Off check to:
P. L. Lyons, Inc. c/o Alyson Stamper
11503 Main St. Middletown, KY 40243
lionsmiddletownky.com
Contact Alyson Stamper (502) 386-7152 or alyson.lyons@gmail.com
Middletown Lions Club
39th Annual Golf Scramble
Registration Form 2017