Sponsorship RequestCompany NameYour Name* First Last Phone*Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email* Enter Email Confirm Email Sponsorship Level*Hole Sponsor - $75Tournament Sponsor - $750 (Golf Foursome Included)Ball Sponsor - $750 (Golf Foursome Included)Title Sponsor - $1000 (Golf Foursome Included)How Would you Like to Pay for your Donation?*PayPalCredit CardWould you like to cover our processing fees as part of your donation?*By taking payments online, we lose money from your donation in the transaction/processing fees. These fees start to add up and are taking money away from the research. IF you would like to help ensure we get the full amount of your donation, please select 'Yes' from the drop-down below and we will add our processing fees (which we are charged, 2.9% +$0.30) to your donation amount.Select OneNoYesProcessing and Handling Fee Price: $0.00 Credit CardAmerican ExpressDiscoverMasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Security Code Cardholder Name Total Purchase Price $0.00 PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms. 6 Shares
