2026 “Well-In” Registration

To register, fill out the form below.

Cost (Including all taxes and gratuity):
Golf and dinner – $175
Dinner only – $85

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Number of people attending

• 1
• 2
• 3
• 4
• Other

Name: *

Activity:

• Golf & Dinner
• Dinner Only

Email: *

Phone #: *

Name:

Activity:

• Golf & Dinner
• Dinner Only

Email:

Phone #:

Name:

Activity:

• Golf & Dinner
• Dinner Only

Email:

Phone #:

Activity: Email:

Name:

Activity:

• Golf & Dinner
• Dinner Only

Email:

Phone #:

Register

Please etransfer your Registration Fee to jdiehltv@rogers.com.