TEST SQUARE Chix with Stix Application Team Name(Required) Team Contact Name(Required) First Last Team Contact Email(Required) Enter Email Confirm Email Team Contact Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Team Member #2 Name(Required) Team Member #3 Name(Required) Team Member #4 Name(Required) Registration Fee(Required)9 holes of golf = $160 per team ($40 a person) 18 holes of golf = $300 per team ($75 a person) 9 holes (team) 18 holes (team) Total Payment Method(Required)Please select your method of payment. Thank you! Credit Card Check Cash Paying with Credit Card:Credit Card Cardholder Name Card Details Paying with Check: Make check payable to The Phoenix Center, with the memo line "Chix with Stix 2022" and mail to: The Phoenix Center 109 E. Lawrence Ave. Springfield, IL 62704 Paying with Cash: Please bring cash to The Phoenix Center (109 E. Lawrence Ave., Springfield, IL, 62704) during our business hours.EmailThis field is for validation purposes and should be left unchanged.
