Hoja de Registro Randy Boaz

You might also like

Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

13/5/2014 Boaz Registration

http://www.randyboaz.com/registration%20form.htm 1/1

Presents
The 14th Annual
Randy Boaz Memorial
ALS COMPETITION
Proceeds to benefit the Randy Boaz Scholarship Fund
REGISTRATION FORM
Agency Name


Agency Telephone & Address


Team Captain Name
Captain's Telephone Number
and Email Address

Team Member #2 Name
Team Member #3 Name
Alternate Team Member Name
Return this form completed along with the registration fee of $175.00 by June 1st, 2014. Assure that names are
legible and spelled properly. Any registration fee or form that is received after June 1st, 2014 will not be
accepted. All checks received are non-refundable.
Make all checks payable to:
Miami-Dade College
Send checks to: Miami-Dade College
Medical Center Campus
Attn: Ricky Barnet
950 NW 20 Street
Miami, Florida 33127

If you have any questions, please feel free to contact Ricky
Barnet at 305-237-4457or E-mail at rbarnet@mdc.edu

You might also like