University of Wyoming First Tee Pro-Am
Jacoby Golf Course
3501 Willet Drive
Laramie, WY
307-745-3111
August 28-29, 2009
www.jacobygc.com
Ticket Form
Name: _________________________________________
Address: _______________________________________
City: ____________________________State: _________
Zip: ______________
Phone: ______________Cell Phone: __________________
Email Address:___________________________________
Circle What Applies: Amateur Professional
Single $20.00
Couple ..$35.00
Table (8) ..$200.00
Payment Type: Check ____ Credit Card____Cash______
**Credit Card Information- We accept Visa & Mastercard:
Name on Account: _______________________________
Type of Card: ___________________________________
Card Account #:__________________________________
Expiration Date: _________________________________
Signature: ______________________________________
Mail To:
Jacoby Golf Course
Attn: University of Wyoming First Tee Pro-Am
Division of Physical Plant, Department 3227
1000 E University Blvd.