• Name
• Organization
• Address
• City
• State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
• Zip
• Phone
• Fax
• E-mail

• I will be a Gold sponsor - $550
  • Includes 5 person team entry fee
  • Signage on two holes ($300 value)
  • Sponsor provided banner at event
  • Sponsor provided full page ad in event program
• I will be a Silver sponsor - $150
  • Acknowledgement in event program
  • Signage on one hole
• I will be a Bronze sponsor - $50
  • Acknowledgement at the event
• Sign up my 5 person golf team @ $75 each before May 6, 2012 or $85 after May 6, 2012
• Sign me up to golf @ $75 prior to May 6, 2012 or $85 after May 6, 2012
  • I understand I will be placed on a team the day of the outing

Only fill this section out if you are a Gold sponsor or a 5 person team.

• 1.
• 2.
• 3.
• 4.
• 5.