2012 Golf Classic Registration

Underwriting

Includes media, press releases, website, program, and banner promotion, (does not include any golfers)

None

Green Fees per Course - $1,500 (North, South, or West)

Par 3 Beverages - $2,100 - In addition signage will be placed on each of the Par 3's

Golf Cart - $100 per cart - In addition a sign will be placed on the golf cart(s)

Registration

Includes promotion on banner, green fees, cart, brunch (NEW!), dinner, door prize, putting contest, beverages, and proximity holes for the number of golfers indicated below.

Place me on an appropriate team: *

Yes

No, my teammates are listed below

Golfers

Golfer #1 Name: *

Golfer #1 Address:

Golfer #1 Email:

Golfer #1 Same Team: *

Golfer #2 Name: *

Golfer #2 Address:

Golfer #2 Email:

Golfer #2 Same Team: *

Golfer #3 Name: *

Golfer #3 Address:

Golfer #3 Email:

Golfer #3 Same Team: *

Golfer #4 Name: *

Golfer #4 Address:

Golfer #4 Email:

Golfer #4 Same Team: *

Company or individual name as it should appear on program, banners, etc.

Company Or Individual Name: *

Billing Address: *

City: *

State: *

Zip Code: *

Phone (with extension): *

Fax:

Email: *

Contact number for the day of the outing: *

Payment:

Payment to follow

* IRS regulations stipulate that registration fees are not tax deductible if there is the opportunity for you to win a prize that is worth more than the cost of the registration fee. Check with your tax advisory if you have any questions. Make checks payable to: The Wilson Memorial Hospital Foundation. Mail to Wilson Memorial Hospital, c/o Bonnie Faulkner, 915 W Michigan St., Sidney OH 45365. Thank you.

Note: If the golf outing is currently full you will be placed on the waiting list. A representative will contact you with more information.

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