2009 March Of Dimes Foursome Form

March of Dimes 2009 Celebrity Golf Classic Sunday, June 7 & Monday, June 8, 2009 at Brookfield Country Club Please complete this entry form and mail with payment as soon as possible to ensure your participation in this year's event Contact Name___________________________ Phone _________________________________

Playing Partner #1_______________________ Company_______________________________ Address________________________________ City________________State____Zip_________ Phone______________Fax_________________ Email _____________________shoe size _____ ____Yes! Our company would like to purchase a Tee & Green sign - $125 per company name Name to appear on sign: ____________________ Playing Partner #2________________________ Company________________________________ Address_________________________________ City________________State____Zip__________ Phone______________Fax__________________ Email _____________________shoe size ______ ____Yes! Our company would like to purchase a Tee & Green sign - $125 per company name Name to appear on sign: _____________________

Round Preference: Morning Shotgun

Afternoon Shotgun

**The first 36 paid foursomes will be placed in the afternoon shotgun unless otherwise specified Please send me sponsorship information

Please mark one of the following categories: EAGLE FOURSOME - $1,750 One complimentary Tee & Green sign per Eagle Foursome

*Company name to appear on Tee & Green sign:

__________________________________ TWOSOME - $900 INDIVIDUAL - $450

Payment Preference: (Payment must be received by June 1)

Playing Partner #3________________________ Company________________________________ Address_________________________________ City________________State____Zip__________ Phone______________Fax__________________ Email _____________________shoe size ______ ____Yes! Our company would like to purchase a Tee & Green sign - $125 per company name Name to appear on sign: _____________________ Playing Partner #4_________________________ Company_________________________________ Address__________________________________ City_________________State____Zip__________ Phone_______________Fax__________________ Email ______________________shoe size ______ ____Yes! Our company would like to purchase a Tee & Green sign - $125 per company name Name to appear on sign: _____________________

Please invoice each playing partner separately Enclosed is check #______ in the amount of ___________ Credit Card: Name_____________________________ Amount: $_________ Number____________________________ Type_______________Exp. ___________

Please make checks payable to: March of Dimes 385 N. French Road, Suite 100 Buffalo, NY 14228 Phone 716-691-3805 Fax 716-691-0240 Contact: Bonnie Barone