2012 Golf Classic Registration

Underwriting

Includes program, media 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 program, media and banner promotion, and number of golfers as indicated

*Registration fee a door prize for each golfer and participation in all raffle, SKINS, putting contest, lunch, dinner, green fee, cart, beverages and a thank you gift from the Foundation.

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: *

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 Cashier, 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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