Company Name: _________________________________________________________ Team Captain: ____________________________________________________________ Address: _____________________________________________________________________ City/State/Zip: ___________________________________________________________ Phone: _______________________
Email: _____________________________________
Team Member #2:_______________________________________________________ Team Member #3: ______________________________________________________ Team Member #4: _____________________________________________________
Sponsorship Level: (Above)
$___
Team Fee: $75 per Golfer($300/Team) Skins Game (Optional $20 per team)
_______ $__________ $___________
$20.00 from each entry donated directly to Missouri Baptist-Sullivan Oncology Dept. ***Please indicate number of carts needed :_________(Country Club has a limited amount of Carts) Make checks payable to: Josh Kaufman Foundation % Madison Kaufman 1153 Watson Road Sullivan, MO 63080 573-927-5762 DEADLINE : September 5, 2012
