Team Captain *

First Name

Last Name

Captain Phone *

(###)

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Captain Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Team Member #2 *

First Name

Last Name

Team Member #2 Phone

(###)

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Team Member #3 *

First Name

Last Name

Team Member #3 Phone

(###)

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Team Member #4 *

First Name

Last Name

Team Member #4 Phone

(###)

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Liabililty Waiver *

By checking the Liability Waiver box, I acknowledge that my participation in the Travis Burkhart Foundation Golf Scramble involves a risk of injury, including bodily injury, and agree to participate at my own risk. On my own behalf and on behalf of my legal representatives, I hereby release all liability or injury, death, or damages and/or any other claims, demands, losses or damages, incurred by me in connection with any aspect of the Travis Burkhart Foundation. I acknowledge that my participation in the TBF Golf Scramble is voluntary and does not constitute as an obligation.