Individual Player & Sponsor Registration

Use this secure form to add your Sponsorship to the tournament or register to play.
Alternatively, you could print, fill-out and mail with a check, or simply call us!

Your Information
Full Name:
Company:
Title:
Email:
Phone:	Include Area Code
Address :
City:
State :	Washington Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia West Virginia Wisconsin Wyoming
Zip :
Player (only) Registration
None 1 @ $325 2 @ $350 3 @ $975 4 @ $1300 5 @ $1625 6 @ $1950 7 @ $2275 8 @ $2600 9 @ $2925 10 @ $3250	$325 per golfer includes Dinner Banquet Ticket
None 1 @ $300 2 @ $600 3 @ $900 4 @ $1200 5 @ $1500 6 @ $1800 7 @ $2100 8 @ $2400 9 @ $2700 10 @ $3000	$300 per golfer does not include Dinner Banquet
Team Registration - Enter Team Names below:
Capt:
Player 2:
Player 3:
Player 4:
Sponsorship Opportunities
Hole Sponsor- with golf $2,500 Includes entry for 4-person team. Enter names below: Capt: Player 2: Player 3: Player 4: Hole Sponsor- without golf $1,700
	Hole-in-One Sponsor $2,500
	Includes entry for 4-person team. Enter names below:
Capt:
Player 2:
Player 3:
Player 4:
	Hole Sponsor- with golf $2,500
	Includes entry for 4-person team. Enter names below:
Capt:
Player 2:
Player 3:
Player 4:
	Hole Sponsor- without golf $1,700
	Putting Green Contest $2,500
	Includes entry for 4-person team. Enter names below:
Capt:
Player 2:
Player 3:
Player 4:
	Lunch Sponsor $2,500
	Includes entry for 4-person team. Enter names below:
Capt:
Player 2:
Player 3:
Player 4:
	Long Drive Exhibition $2,500
	Includes entry for 4-person team. Enter names below:
Capt:
Player 2:
Player 3:
Player 4:
None 1 @ $25 2 @ $50 3 @ $75 4 @ $100	Sponsors have the opportunity to purchase up to four additional Live Auction Dinner Banquet tickets at the reduced rate of $25/each.
Payment Information
Card type:	VISA MasterCard AMEX
Name on card:
Card Number:
Expiration:	Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 2011 2012 2013 2014 2015 2016
CCV Code	(CCV security code)
Need assistance or more information? Contact:
Meg Diemer: Development Coordinator
Phone:	(425) 827-0132
FAX:	(425) 822-4750
Email:	mdiemer@positiveplace.org
Kirkland Boys & Girls Club
	10805 124th Avenue NE
	Kirkland, WA 98033