Lone Star Transplant Games
San Antonio, Texas
Registration Form
Check options, print this page, fill in and mail or FAX
Please send the required waivers with this form.

Print Name: _________________________________________________________

Mailing Address: _____________________________________________________

City ______________________________________   State: _____   Zip: ________

Day Phone: ______________________   Evening Phone: ______________________

Fax Number: ____________________   E-mail: _____________________________

Age: _____   Male   Female

  Transplant  Type of transplant _______________   Date of transplant: _________
  Recipients:   Hospital: ______________________  City:______________   State: ___
 
Select your event: Bowling · Bowling shirt size: ____       Golf · Golf shirt size: ____
Golf: $75  ·  Bowling $15 (Kids $7.50)  ·  Sunday Banquet: $20
 
  Make check payable to   Amount due for registration: __________
Lone Star Transplant Games +   Amount due for banquet: __________
  =              Total amount due: __________
Please try to find a sponsor in your area for financial assistance.
 
Payment Deadline is Sept 10, 2008 to get a golf shirt.

Mail or Fax this form Lone Star Transplant Games Phone: (210) 421-8775
with payment to: 8122 Datapoint Drive, Suite 200 FAX:   (210) 614-2129
  San Antonio, TX 78229  
Home Page  ·   Back