Golf Event Order Form

Night Shelter Donation

* 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:

Sponsorship level (please check one):
      $1000.00 to sponsor a family of 3 for 30 nights in shelter
      $500.00 to sponsor a mother and child 20 nights in shelter
      $300.00 to sponsor a mother and child 12 nights in shelter
      $150.00 to sponsor one woman 12 nights in shelter
      $50.00 to sponsor a mother and 3 children 1 night in shelter
      $25.00 to sponsor a woman 2 nights in shelter
      $12.50 to sponsor a woman 1 night in shelter
      Donation of any amount is appreciated

Please accept my gift in memory/honor of:

1. E-mail the form by clicking the Send the Information button at the bottom.

OR

2. Print it and mail it to CSADV with payment to:
CSADV, P.O. Box 1565, Sioux City, IA 51102

OR

3. Fax to CSADV.
Fax: 712-258-8790
Phone: 712-277-0131