Please fill out the Confirmation Form on a seperate TAP

CONFIRMATION SHEET                             APRIL 17, 2012 TO APRIL 21, 2012

NAME:

COMPANY:

ADDRESS:

PHONE:

E-MAIL:

WEB:                                        CELL:

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                                                                                                              YES OR NO

1. SUNDAY (4-15-12) DO YOU WANT RESERVATION?           (      )

2. MONDAY (4-16-12) DO YOU WANT RESERVATION?         (     )

3. TUESDAY (4-17-12) AFTER NOON,  

    WILL YOU BE PLAYING GOLF?                                          (      )

4. FULL PAYMENT. (DUE MARCH 10, 2012 ) ---------$ 635

5. PLEASE MAKE CHECK PAYABLE TO:  AL LEVESQUE/JACOBS RAIDERS

6. MAIL CHECKS AND CONFIRMATION SHEET TO:                                                 

                                          AL LEVESQUE

                                           11 IVY LANE

                                            CHERRY HILL, N.J. 08002

E-MAIL:                                      LEVESQUEAP@AOL.COM

Phone: 856-667-1742                                                                          Cell: 856-520-1170