Lew Rudin Charity Golf Classic - Order Form

Part 1 - Billing Information
Full Name *

First Name Last Name
Company
Daytime Number *

Area Code Phone Number
Fax Number

Area Code Phone Number
E-mail *

Billing Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Part 2 - Payment Information
Select your level of participation below

Underwriter - As an Underwriter, you will be entitled to a round of golf for 4 people and acknowledgement in the golf program and prominent recognition at one of the holes on the golf course.

Sponsor - As a sponsor, you will be entitled to a round of golf for 2 people and acknowledgement in the golf program and recognition at one of the holes on the golf course.

Individual - As an individual, you will be entitled to a round of golf.

Dinner Only - I will only be attending the dinner and awards or will bring a guest - $400 per person (limited availability).

Participation Level *

Underwriter [4 Golfers] $ 12,000.00

Sponsor [2 Golfers] $ 6,000.00

Individual [1 Golfer] $ 1,200.00

Quantity

Dinner Only $ 400.00

Quantity

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Part 3 - Participant Information
Golfer #1

First Name Last Name
Shirt Size
Handicap
Golfer #2

First Name Last Name
Shirt Size
Handicap
Golfer #3

First Name Last Name
Shirt Size
Handicap
Golfer #4

First Name Last Name
Shirt Size
Handicap
Should be Empty: