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Midlands Golf Benefit 2010 Registration

Name*
Company (if applicable)
Address*
City*
State*
Zip*
Home phone*
Work phone*
Email*
FCA HDCP Index*
Others in foursome
Name player 2*
Address player 2*
City player 2*
State player 2*
Zip player 2*
FCA HDCP Index player 2*

Name player 3*
Address player 3*
City player 3*
State player 3*
Zip player 3*
FCA HDCP Index player 3*

Name player 4*
Address player 4*
City player 4*
State player 4*
Zip player 4*
FCA HDCP Index player 4*
Please check all that apply:
	Title Sponsor - $10,000
	Corporate Sponsor - $5,000
	Tournament Sponsor - $2,500
	Team Sponsor - $1,250
	Sign Sponsor - $150
If sponsoring signs, how many?
	Please include team mulligans (2 per golfer)
	Mulligan per player - $25.00 each
	Team Mulligan - $100.00 per team
Mail checks to: Midlands FCA Office 100 Executive Center Drive Suite A-4 Columbia, SC 29210
For more information phone: (803) 798-1142

* indicates a required field

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