23rd Annual Terra Charity Golf Classic

* denotes required fields
This form can be e-mailed or printed for mailing and faxing, Contact 712-277-0131 for more information


*Your E-mail:

*Name/Company:

*Address:

*City: *State: *Zip:

*Phone:

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Sponsorship level (please check one):   

Platinum ($10,000)          Gold ($3,500)                Silver ($1,500)

Tee/Green Sponsorship (unless included in sponsorship package):
I want to sponsor (quantity) tee(s) or green(s) @ $250 each (recognition at tee or green).

Sponsor(s)/Company(ies) name(s) for signs:

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Golf Participants at $300 each:

  Banquet: Yes No

  Banquet: Yes No

  Banquet: Yes No

  Banquet: Yes No

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I/We prefer to golf with:

Name: Company:

Name: Company:

Name: Company:

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Super ticket advance purchase at $50 each:

(Super ticket includes 5 raffle tickets,

4 mulligans, 1 sleeve golf balls, tees, ball markers)

Number of additional guests for banquet only at $50 each:

Charitable contributions: I would like to make a fully tax deductible contribution of

NOTE: No refunds

General Waiver and Release:

I hearby waive all claims against CSADV and event sponsors, for any injury I might suffer at this event.  I attest that I am physically fit and prepared for this event.  I grant full permission for organizers to use photographs and quotations from me in legitimate accounts and promotions of this event.

*Check hear to agree to the above waiver: