Life Promotions Charity Golf Outing Registration F

Life Promotions Charity Golf Outing Registration Form

Monday, June 10, 2013 • North Shore Golf Club • Menasha, WI

All form fields marked with a * are required.

Choose your Pay to Play Option * I will be playing under a corporate sponsor. I will be a four-some corporate sponsor for $1000. I will be submitting 50 or more sponsor names to participate for free.
(Must raise a minimum of $500. Registrant agrees to pay difference by June 17th if goal of $500 is not met.) I will make a payment of $500 to participate.
Name * First Last
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Home Phone - (###) - ### ####
Cell Phone - (###) - ### ####
Email *
Date of Birth * / MM / DD YYYY

If under 18, parental or guardian permission is required.
CLICK HERE to fill out form. Email completed form HERE or mail to:
Life Promotions - Attn. Carla, 4 N. Systems Dr. Ste C, Appleton, WI 54914
Gender * Male Female
Do you have a facebook account? Yes No
Referred By and/or Corporate Sponsor
Does your employer/ company have a fund matching program? Yes No
Shirt Size *
Emergency Contact Name * First Last
Emergency Contact Phone * - (###) - ### ####
Emergency Contact Relationship *
Liability Waiver

I know there is an element of risk in playing golf. I assume all risks and danger of personal injury and any hazards in any way related to the golf outing including, but not limited to: danger from golf balls, golf clubs, carts, course hazards or actions of other participants and non-participants. I certify that I am fit for the challenge of the golf outing. I hereby release and will not hold the host organization, Life Promotions, Inc., the management and owners of the host course, North Shore Golf Club, and their respective officers and employees liable from any and all liability, actions, debts, and claims resulting from the golf event or causes listed above. By clicking the "Submit Registration" button I indicate my acceptance of this waiver.

Life Promotions Charity Golf Outing Registration Form

Liability Waiver