Eighth Annual DeCesaris/Prout

                Championship Golf Tournament

               Twin Shields Golf Club - Friday, June 25, 2010

18^th Hole Dedication Flag Order Form

The 18^th hole is dedicated to family members, friends, and loved ones who have suffered with or been touched in some way by cancer.  Please join us in celebrating their courage and honoring or memorializing their lives.

Dedication flags cost $35 (tax-deductible), and proceeds will benefit the DeCesaris/Prout Cancer Foundation research programs for lung and ovarian cancer.  You do not need to be present to take part in this tribute.  With your donation, the name of your family member or friend will be placed on a dedication flag and placed along the 18^th fairway, creating a symbol of hope and wonderful tribute to the loved ones for whom the flags are dedicated.

Donor Name:  ___________________________________________________

Address:          ___________________________________________________

City/State/Zip:            ___________________________________________________

Daytime Phone:          _____________________      E-mail: ____________________

I would like # ______ Dedication Flag(s) x $35 = Amount Enclosed: _____________

Please print clearly to ensure accuracy of names (please photo-copy form if additional space is needed.)

In Honor of:                                                                            In Memory of:

1.)      ________________________                                   1.) _________________________

2.)      ________________________                                   2.) _________________________

3.)      ________________________                                   3.) _________________________

4.)  ________________________                                    4.) _________________________