Print and mail this application to: 

Golf Mind Power & Investment Seminar 
C/O Steve Selengut 
3906 Betsy Kerrison Pkwy 
Johns Island, SC 29455 

Please complete and return ASAP as space is limited. Print one application per person and fill out one form with each player's information. 

Name: ______________________________Company_________________________________ 

Address: _____________________________________________________________________
 
City: _______________________________________ State: ______ Zip: _____________
 
Email: _______________________________________________________________________ 

Phone Number(s): Home _________________________ Work __________________________ 

Cell __________________________ 

Handicap: _______ (OR) Average Score for 18 holes: _________ 

YES, I would like to be a program sponsor and have enclosed $125. 
(Sponsor fee is $125. or Free for registering a foursome.) 

Two to three lines of information you would like in the program: (or attach a separate sheet) 

Check one that is appropriate (Deposit or paid in full; one or more persons):

. Per person Seminar paid in full $495____.

. Foursome Seminar paid in full $1,980_____. 

. Per person 50% Deposit $247.50____.

. Foursome 50% Deposit $990_____. 

Total amount enclosed __________________ 


NOTE: All applications must be accompanied by minimum of a 50% deposit made payable to GOLF MIND POWER. Balance due by October 2, 2009. 

For more information: sanserve@aol.com or call 843-243-0494 


Thank you for your cooperation.