Secure online sign-up for the
2011 Golf Scramble
Friday, September 30
Shotgun start at 12:30 pm
Dinner at 5:30 pm

Plum Tree National Golf Course
(www.plumtreegolf.com)
Map/Directions


Be there for great raffle prizes!


Help make this annual event the most successful ever. Your sponsorship allows us to support high-quality health care services for the residents of Harvard and surrounding communities.

Sponsorship and Participation Levels *
(Please check one)

$500: Golf for 4, carts, dinner, hole sponsorship and one raffle ticket
$300: Golf for 2, carts, dinner, hole sponsorship and one raffle ticket
$250: Golf for 2, carts, dinner, and one raffle ticket
$150: Golf for 1, cart, dinner and one raffle ticket
$100: Golf for 1, cart and dinner
$75: Hole sponsorship only
$50: Raffle ticket only
$25: Dinner ticket only


Participant Name 1:*
Participant Name 2:
Participant Name 3:
Participant Name 4:
Company:
Address:*
City:*
State:*
Zip:*
Phone (with area code):*

 

Payment Method

 
Sending check
(Please mail to Harvard Memorial Hospital Foundation, 1003 Grant Street, Harvard, IL 60033)

Bill my MasterCard or Visa.

  Credit Card Number:* - - -
Expires:
  Card Security Code: (3 digit for MC/Visa, 4 digit for AMEX)
  Name on Card:
  Card Billing Address:
Comments:

If you prefer call Tom Jensen at (262) 949-2341.

Thank you for your support!!!!