Registration Form - The Hope Center for Autism

Hope Center Tourn Reg Form.qxp_Layout 1 1/20/15 12:38 PM Page 1
PARTICIPANT REGISTRATION INFORMATION
Please fill out this form as you would like it to appear for sponsorship information. Please email your logo to
[email protected] This information will be used as it appears in this section.
SPONSORSHIP OPPORTUNITIES - COMPANY NAME:__________________________
I would like to support the Hope Center with a sponsorship:
____ Hope Sponsorship ($5,000)
____ Wish Sponsorship ($900)
____ Hole Sponsorship ($200)
____ Learning Sponsorship ($2,500)
____ Connections Sponsorship ($1,500)
____ Tee Sponsorship ($150)
Credit card information:
Name as it appears on card __________________________________
Card type:
Visa
Mastercard
American Express
Discover
Card #: ______________________________ CVC: ____ Exp. ____
Address:__________________________________________________
Ciy, State, Zip: ____________________________________________
Signature: ________________________________________________
❍ I have enclosed a check for my sponsorship.
Pay online at www.hopecenterforautism.org
Name: ______________________ Handicap ________
Address: ____________________________________
____________________________________________
Phone: ______________________________________
I cannot attend; however I
would like to show my support
with a donation.
❍ $25.00
❍ $50.00
❍ $100.00 ❍ Other $_________
E-mail:______________________________________
❍
❍
❍
❍
I paid online.
I am an individual player, and I have enclosed a check for $200 (Golf/Lunch).
I am part of a foursome and have enclosed a check for $700 (Golf/Lunch).
Additional lunch - $25.
ADDITIONAL PLAYERS:
PLAYER 2: Name:______________________________ Handicap: __________
PLAYER 3: Name:______________________________ Handicap: __________
PLAYER 4: Name:______________________________ Handicap: __________
ADDITIONAL LUNCH:
Name: ________________________________________ Email: __________________________
Name: ________________________________________ Email: __________________________
Please mail or fax this form - deadline for entry is aPril 10, 2015
1695 se indian street • stuart, florida 34994 | Ph: 772-334-3288 • fax: 772-872-7229
for registration, payment or more info go to: www.hopecenterforautism.org