Quality of Life Health Services, Inc.
Student Scholarship Program and Golf Tournament Registration Form
Golfer 1
Golfer 2
_____________________________________________
_____________________________________________
Name
Name
_____________________________________________
_____________________________________________
Address
Address
_____________________________________________
_____________________________________________
City
State
Zip
City
State
Zip
_____________________________________________
_____________________________________________
Telephone Number
Telephone Number
_____________________________________________
_____________________________________________
E-mail Address
E-mail Address
Single Player
Team
Single Player
Team
_____________________________________________
_____________________________________________
Organization/Sponsor
Organization/Sponsor
Additional golfers can be added to the back of this form.
Registration Deadline: Friday, September 23, 2016
$90 per player
Sponsorship Level:
 Event Sponsor ($5,000)
 Platinum Sponsor ($2,500)
 Gold Sponsor ($2,000)
 Silver Sponsor ($1,500)
 Lunch Sponsor ($1,500)
 Hole Sponsor ($100)
 Donation________
Please return this form and payment to:
Quality of Life Health Services, Inc.
c/o Tiffany Hawkins
Post Office Box 97
Gadsden, AL 35902
Please make checks payable to:
Quality of Life Health Services, Inc.
Payment Method:
 Cash
 Check
Contact Person:
Shaftel Benson
(256) 439-6340
[email protected]
Quality of Life Health Services, Inc. is a 501(c)3 organization.
All sponsorships and contributions are tax-deductible to the extent allowed by law.
Golfer 3
Name:
Address:
City:
State:
Zip:
Telephone Number:
Zip:
Telephone Number:
Zip:
Telephone Number:
Zip:
Telephone Number:
Zip:
Telephone Number:
Zip:
Telephone Number:
E-mail Address:
Single Player
Team
Organization/Sponsor:
Golfer 4
Name:
Address:
City:
State:
E-mail Address:
Single Player
Team
Organization/Sponsor:
Golfer 5
Name:
Address:
City:
State:
E-mail Address:
Single Player
Team
Organization/Sponsor:
Golfer 6
Name:
Address:
City:
State:
E-mail Address:
Single Player
Team
Organization/Sponsor:
Golfer 7
Name:
Address:
City:
State:
E-mail Address:
Single Player
Team
Organization/Sponsor:
Golfer 8
Name:
Address:
City:
State:
E-mail Address:
Single Player
Team
Organization/Sponsor: