Charity Golf Reg. Form (PDF)

Sponsorship and Team Registration Form
NAIFA-CV 13th Annual Charity Golf Tournament
to benefit the Charlottesville Free Clinic
May 23, 2011— Glenmore Country Club

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registration, golf team registration is on the reverse side.

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We have several opportunities to sponsor and support
the 13th Annual Charity Golf Tournament to benefit the
Charlottesville Free Clinic. See below for sponsorship

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Sponsor contact Information
Name/Title _________________________________________

Company Name ________________________________________

Address _____________________________________________

City/State/Zip___________________________________________

E-mail _______________________________________________

Phone ________________________________________________

Sponsorship Opportunity

q Dinner Sponsor — $2,000
q Special Sponsor — $1,200
q Hole Sponsor — $150
q We would like to provide giveaways for the player goody bags —­ total 125 items.
q Donate to silent Auction/Raffle
q Team Only — see reverse side of this sheet for team registration
Silent Auction/Raffle Donation
Description of item ____________________________________________________________________________________________________
Restrictions ____________________________________________________ Expiration Date ________________________________________
Fair Market Value of Donated Item $_____________________________

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Please check here if you need the Charlottesville Free Clinic to pick up item.

RECEPTION/Dinner/Silent Auction only

— $75 per person
Another great way to participate in this event is to join us for our reception, dinner, and silent auction. We will have exciting
,auction items, great food, and fun company. If your are interested in the evening event, please fill out the registration area below.

Name ______________________________________________

Name _________________________________________________

Address _____________________________________________

Address ________________________________________________

E-mail _______________________________________________

E-mail _________________________________________________

Phone ______________________________________________

Phone ________________________________________________

Please see team registration and payment options on reverse side of this sheet

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Team registration for foursomes includes: range, golf, cart, goody bag, raffle and hole prizes.
Followed by a silent auction and dinner for each participant plus a spouse or guest. If you would
like to attend as a dinner guest only and participate in the silent auction please fill in the
information under dinner guest only.

Team Information ($700 per team, $175 per golfer)
#1 Golfer Name ____________________________________

#3 Golfer Name ____________________________________

Address _____________________________________________

Address _____________________________________________

_____________________________________________________

_____________________________________________________

E-mail _______________________________________________

E-mail _______________________________________________

Phone ______________________________________________

Phone ______________________________________________

USGA Handicap/Home Course ________________________

USGA Handicap/Home Course ________________________

Dinner Guest Name __________________________________

Dinner Guest Name __________________________________

#2 Golfer Name ____________________________________

#4 Golfer Name ____________________________________

Address _____________________________________________

Address _____________________________________________

_____________________________________________________

_____________________________________________________

E-mail _______________________________________________

E-mail _______________________________________________

Phone ______________________________________________

Phone ______________________________________________

USGA Handicap/Home Course ________________________

USGA Handicap/Home Course ________________________

Dinner Guest Name __________________________________

Dinner Guest Name __________________________________

Payment

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Check is enclosed. (Please make checks payable to Charlottesville Free Clinic.)
Please charge my credit card (

Amount

q Visa

or

q MasterCard)

$__________________________________________________

Card Number _______________________________________________

Expiration Date ________________________________________

Signature/Date _______________________________________________

Zip Code of billing address _______________________________

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I will pay on the day of the tournament.

Questions?
Contact CFC Development Assistant Kelly Durkin at 434.295.0008 or kelly@cvillefreeclinic.org.

Return registration form
Please return this registration form and check (if applicable) to Charlottesville Free Clinic in enclosed reply envelope.
For more information please view cvillefreeclinic.org/golf. Registration forms are due by May 16, 2011.