Registration Form


 

AzMN UA Golf TournamentUA Golf Registration

UA 2011 GOLF TOURNAMENT REGISTRATION

 

Mail to:
Arizona Myeloma Network (AzMN)
20280 N. 59th Ave. Suite #115 448
Glendale, AZ 85308

FAX to 623-243-6580 or Email to azmyelomanetwork@cox.net

DOWNLOAD 2011 Golf Brochure

Please fill out the form below and include payment: 

Company Name

Contact Name (required)

Address (required)

City, State, Zip (required)

                   

Phone Number (required)

Email Address

Player 1 Name  Handicap/Avg. Score   Phone #
Player 2 Name  Handicap/Avg. Score   Phone #
Player 2 Name  Handicap/Avg. Score   Phone #
Player 4 Name  Handicap/Avg. Score   Phone #

Foursome: $1,000, Single: $250
Includes Breakfast, Golf Cart, and Lunch

Non-Golfers Please Register for Lunch Here

Non-Golfer Lunch Name

 

Payment Options
      ____ Check payable to AzMN      _____ Credit card: [   ] MC  [  ] Visa  [  ] Discover
Account #  ____________________  Exp. Date  ________  Name on Card  ______________________________

Signature  __________________________________
____ PayPal. Make payment at:      www.paypal.com to: azmyelomanetwork@cox.net
I am unable to participate. Please accept my deductible contribution of $ payable by PayPal at email address azmyelomanetwork@cox.net.


SPONSORSHIPS


______  Special Reception  $10,000                       Ads:      ______   Full Page $1,000
______  Platinum  $10,000     ______  Silver  $5,000          ______   Half Page $750
______  Gold  $7,500              ______  Bronze  $2,500        ______   Quarter Page $500

TOTAL PAYMENT WITH SPONSORSHIPS: ______________________________

Individuals Check Here:  Please register me as an individual player for the tournament.

Additional Information


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This form will be emailed to the Arizona Myeloma Network.  All information submitted in this form is kept private and the personal information you supply to Arizona Myeloma Network (AzMN) will not be given, sold, rented, loaned, or otherwise disclosed to any third parties outside of Arizona Myeloma Network (AzMN), except when we have your permission or under special circumstances, such as when we believe in good faith that disclosure is reasonably necessary to (i) comply with legal process, (ii) enforce the Terms of Use, (iii) respond to claims that any content on Arizona Myeloma Network (AzMN) violates the rights of third parties, or (iv) protect the rights, property, or personal safety of Arizona Myeloma Network (AzMN), its users, or the public.