6th Annual Clubs for Colorectal
Cancer Golf and Benefit Dinner
Presented by the Division of Colon And Rectal Surgery
Friday, June 9, 2017—Shotgun start at 1pm
Blackstone National Golf Club
222 Putnam Road, Sutton, MA 01590
Individual Sponsorship Sign-up
Please select desired sponsorship & return completed form to our office
Major Sponsorship - $1,000
Exclusive hole sponsorship in GPS system; recognition in event program;
logo recognition at the registration table; logo recognition on colorectal
quick fact table card, in slideshow during dinner service.
Eagle Level Sponsorship - $350
Exclusive hole sponsorship with logo recognition in GPS system;
recognition in event program; logo recognition on colorectal quick fact
table card and in slideshow during the dinner service.
Birdie Level Sponsorship - $250
Exclusive hole sponsorship with logo recognition in GPS system;
recognition in event program.
Hole Sponsorship - $150
Quick Fact Sponsorship - $50
Logo recognition on colorectal quick fact table card and in slideshow
during dinner service.
Golf and/or Dinner Sign-up
Player Slot
$125
Dinner Guest(s) $50
Four-some
$500
Name_______________________________________________
Player Information:
Player #1 Name: __________________________________
Player #2 Name: __________________________________
Player #3 Name: __________________________________
Player #4 Name: _________________________________
Payment Information
Name: __________________________________________
Address: ________________________________________
Phone: ­­­­___________­­­­_________________________
E-mail:__________________________________________
Method of Payment:
Check – Payable to: UMMF Colorectal Cancer Fund
MasterCard
Discover
American Express
Visa
Credit Card No. ___________________________________
Expire Date:___________
Signature: _______________________________________
Completed forms and payment be mailed to:
UMass Memorial Division of Colon & Rectal Surgery
c/o Justin Maykel
67 Belmont St. Suite 201
Worcester, MA 01605
Questions?
Call: 508-769-4769 or email [email protected]
or [email protected]