Primary Contact

Primary Contact First Name

Primary Contact Last Name

Primary Contact Phone Number

Primary Contact E-Mail Address

Billing Address

City

State

Zip Code

Sponsorship Options

Sponsorship Level

Scoreboard Level - $800 (4 Players)

Gold Level - $700 (4 Players)

Team Sponsor Name - To be listed in recognition materials

Game Package ($40): Each team receives 1 golf ball raffle & 1 String Ball Set

Yes

No

Is your business interested in donating a Flag Prize?

Yes

No

Payment Option (Please use your confirmation email as an invoice)

Pay via Credit Card by calling Heartland United Way at (308) 382-2675

Pay via check sending to Heartland United Way, 1441 N Webb Road, Grand Island, NE 68803

Do you consent to a photo release for your team?

Yes

No

Golfer 1

Team member names do not need to be secured at time of Registration.

First Name

Last Name

E-mail Address

Phone Number

Golfer 2

First Name

Last Name

E-mail Address

Phone Number

Golfer 3

First Name

Last Name

E-mail Address

Phone Number

Golfer 4

First Name

Last Name

E-mail Address

Phone Number

SECURITY QUESTION: What state are we located in?

Submit

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