Friends of St. Anthony's Golf Benefit Registration

REGISTRATION FORM

Friends of St. Anthony’s Memorial Hospital

6th Annual Golf Benefit

Effingham Country Club

Friday, July 18, 2014

Entry Deadline July 3 | Four-Person Scramble | No Handicaps

Please select your level of sponsorship:

[ ] JACK NICKLAUS SPONSOR - $5,000

[ ] GARY PLAYER SPONSOR - $2,500

[ ] SAM SNEAD SPONSOR - $1,500

[ ] BEN HOGAN SPONSOR - $750

[ ] PUTTING GREEN SPONSOR - $500

[ ] SINGLE PLAYER - $200

[ ] TEE SPONSOR (without Golfers) - $100

[ ] DINNER TICKET - $25

[ ] I want to purchase raffle tickets -- my selections are on back.

Sponsor/Company Name___________________________________________­­­­­­­­­­­­­­­­­­­­_____________________

Address______________________________________________________________________________

City State Zip__________________________________________________________________________

Contact Person________________________________________________________________________

Phone Number_________________________________________________________________________

E-Mail________________________________________________________________________________

My Tee Sponsor Sign Will Read____________________________________________________________

Captain___________________________________ Player 3_____________________________________

Player 2___________________________________ Player 4____________________________________

[ ] I wish to be added to a foursome

[ ] I am unable to participate. Please accept my donation in the

amount of $________________

Bring your Friendship Medallion Coin from a previous year’s Golf Benefit to receive a complimentary Mulligan and a Raffle Ticket

Please make checks payable to:

“Friends of St. Anthony’s Memorial Hospital”

Completed forms may be sent via:

E-mail: michael.wall@hshs.org or   Fax: 217-347-1313

Payment for all sponsorships, players, and raffle tickets along with completed forms can be mailed to:

Friends of St. Anthony’s, 503 N. Maple St., Effingham IL 62401