* First Name:
* Last Name:
* Email:
Street Address:
City:
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* Zip / Postal Code:
Phone:
Name to Appear on Tee:
Address of honoree:
Address of donor:
Your Choice of Hole (#1 - #18):
Your Choice of Core Value:
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*Choice of hole and core value is based on availability and is determined on a first come, first served basis. A representative from the East Lake Foundation will contact you in the next couple of days.

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