7th Annual Dr. Kvitko Golf Outing
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Registration Type: *
Contact Name: *
Mailing Address *
With City, State & Zip
Telephone Number *
Email Address *
Golfer Information
Golfer #1 Name & Email
Golfer Information
Golfer #2 Name & Email
Golfer Information
Golfer #3 Name & Email
Golfer Information
Golfer #4 Name & Email
Golfer’s names can be submitted at a later date to drkvitko@aol.com.
To pay by check, please make payable to the Dr. Kvitko Charitable Fund.  Credit card payments can be made through PayPal to drkvitko@aol.com.

If inclement weather forces the golf course to close, this tournament will be cancelled with no refunds.

Please mail your registration and or payment to Dr. Kvitko & Associates, 4308 North High Street, Columbus, Ohio 43214 (614) 262-9588 or fax your registration to (614) 262-4159 by September 3, 2013.
Would You Like to Donate?
No matter if you do or don't attend, the Dr. Kvitko Charitable Fund will still accept charitable donations. Please enter the amount you would like to donate in the following space.
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