Golf Classic

An opportunity to tee off in support of West Lincoln Memorial Hospital. Your golf cart is waiting for you!

1. Donor Information

2. Title: *
   Dr. Mr. Mrs. Ms
3. First Name: *
4. Last Name: *
5. Organization:
6. Phone: *
7. Email: *
8. Street: *
9. Unit/Apt:
10. City: *
11. Province/State: *
12. Country: *
    Canada USA
13. Postal/Zip Code: *

14. Donation Information

15. Sponsorship Categories

16. Sponsorship Amount:
17. Hole in One:
    $500.00

    Description: Please indicate wine delivery date below
18. Putting Contest:
    $500.00

    Description: Please indicate wine delivery date below
19. Wine Delivery Date:
20. Driving Range:
    $500.00
21. Placement Advertising:
    $250.00

22. Registration

23. Golfers:
    $250.00
24. Guest Name(s):
25. Foursome Information:

26. Payment Information

27. Total:
    $0.00
28. Card Holder:
29. Card Number:
30. CVV/CVC:
    3-digit value located on back
31. Expiry:
    01 - January 02 - February 03 - March 04 - April 05 - May 06 - June 07 - July 08 - August 09 - September 10 - October 11 - November 12 - December 2019 2020 2021 2022 2023 2024 2025

32. Miscellaneous

33. Additional Comment(s):

34. Confidentiality

    I understand that West Lincoln Memorial Hospital Foundation Inc. will keep my donation information I provided here confidential and agree that the Foundation may forward information or requests for donations in the future.

35. Save