Registration Form

Organization Name Please provide your organization's name; it may contain only numbers, letters, spaces and - , . '

Address Line 1 Please provide an address; it may contain only numbers, letters, spaces and - , . '

Address Line 2 Address line 2 may contain only numbers, letters, spaces and - , . '

City City may contain only numbers, letters, spaces and - , . '

State State is required.

ZIP Code ZIP Code is required. It must be exactly 5 digits.

Main Contact

First Name Contact First Name is required. It may contain only letters.

Last Name Contact Last Name is required. It may contain only letters.

Email Contact Email is required.

Phone Phone is required. It must be in the format xxx-xxx-xxxx

Registration Fees

Gold Sponsor ($9,000) Includes 4 Golf Players & 4 Dinner Guests

Silver Sponsor ($6,000) Includes 2 Golf Players & 2 Dinner Guests

Bronze Sponsor ($4,000) Includes 1 Golf Player & 1 Dinner Guest

Hole Sponsorship ($2,000)

Additional Players & Dinner Guests (Not Included in the Above)

Golf Players ($600/ea.)

Dinner Only Guests ($200/ea.)

(Includes Golf, Cart, Gift Bag, Lunch & Beverages on Course, Cocktails & Dinner)

(Includes Cocktails & Dinner in the Evening)

Additional Donation

$ Additional donation must be a positive dollar amount, and must be in the format $0000.00.

Total Golf Players

Total Dinner Guests

Grand Total

Payment Method