CMH Medical Excellence Golf Tournament 22nd Annual CMH Medical Excellence Golf Classic Entry Form

Name of sponsoring business/organization:
Preferred Tee Time:
7:30 a.m.
Sponsorship Level:
Two teams, two sponsor packages, eight player packages, breakfast/lunch/awards ceremony for each player, four banners, six hole signs and acknowledgement in program.
Two teams, two sponsor packages, eight player packages, breakfast/lunch/awards ceremony for each player, two banners, four hole signs and acknowledgement in program.
One team, four player packages, breakfast/lunch/awards ceremony for each player, one banner, two hole signs and acknowledgement in program.
One team, four player packages, breakfast/lunch/awards ceremony for each player, one hole sign and acknowledgement in program.
Recognition on signage at hole-in-one, closest-to-the-pin and longest drive contests and acknowledgement in program.
Acknowledgement in program.
Team Contact Person:
Name:
Phone:
Fax:
Email:
Team Registration:

Player 1

Polo Size
Player 2 Polo Size
Player 3 Polo Size
Player 4 Polo Size
2nd Team: Only enter for Classic Underwriter and Classic Premier Partner

Player 1

Polo Size
Player 2 Polo Size
Player 3 Polo Size
Player 4 Polo Size
Payment Options:

Make checks payable to: Citizens Memorial Healthcare Foundation.
Please mail check to: Citizens Memorial Healthcare, Marketing Department, 1500 N. Oakland, Bolivar, MO 65613

Payment must be made in full prior to play.
Complete the billing information section below.
Billing Information:
Name On Credit Card:
Credit Card Number: Invalid format.
Credit Card Type:
Expiration Date:
CSC:
Address Information:
Address:*
City:*
State:*
Zip:*

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This form will be received and processed by a CMH Employee. A receipt will be emailed to the address provided in this form once the credit card has been charged.