First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Cell Phone

Alt Email

Company Name

Team Name*

Main Contact's Name*

Sponsor Level
Choose all that apply: Title Sponsor: $3,000 Diamond: $1,000 Emerald: $500 Ruby: $250 Hole/Team Sponsor: $550 Hole Sponsor: $150 Golf Team: $115 per golfer Promotional Items: Donation for grab bags Monetary Donation

Payment type*
Choose one: Check (payable to DITR) Visa Mastercard Send invoice to main contact

1. Team Member's Name

Full Address

Phone

Email

2. Team Member's Name

Full Address

Phone

Email

3. Team Member's Name

Full Address

Phone

Email

4. Team Member's Name

Full Address

Phone

Email