To place your reservation by fax, send completed form to: Rosanne Slattery at (516) 747-0714 or mail completed form with payment to: LICADD, 114 Old Country Road, Suite 114, Mineola, NY
All reservations must be received by September 15, 2012.
I/we would like to support the R. Brinkley Invitational as a:
| ___ Platinum Sponsor |
|
$25,000 |
| ___ Gold Sponsor |
|
$10,000 |
| ___ Silver Sponsor |
|
$6,000 |
| ___ Bronze Sponsor |
|
$3,500 |
| ___ Golf Foursome |
|
$2,800 |
| ___ Individual Player |
|
$750 |
| ___ Dinner Reception |
|
$200 |
Course Preference: ___The Creek ___Piping Rock Club ___No Preference
(We will do our best to honor all course preferences; however, course preference cannot be guaranteed.)
I/we would like to help support the R. Brinkley Smithers Invitational by being an underwriter at the following level:
| ___ Dinner Sponsor | $10,000 | ___ Hole Sponsor (w/ Pin Flag) | $1,500 | |
| ___ Golf Cart Sponsor | $5,000 | ___ Photography Sponsor | $1,000 | |
| ___Brunch Sponsor | $3,500 | ___ Print Sponsor | $500 | |
| ___Driving Range Sponsor | $3,000 | ___ Pin Flag Tee Sign Package | $300 | |
| ___ Pin Flag(s) | $200 | |||
| ___Putting Green Sponsor | $2,500 | ___ Tee Sign(s) | $150 | |
| ___Awards Sponsor | $2,000 | ___ Raffle Ticket(s) | $100 | |
| ___Beverage Cart Sponsor (Creek only) |
$1,500 | ___ 6 Raffle Tickets | $500 |
May we request, if possible, payment by check, which is not subject to additional credit card fees.
Please check with your company’s grant plan as many will
match or double the contribution of present or former employees.
| Enclosed is my check made payable to LICADD for $__________. |
___Visa ___MasterCard ___Amex Total $___________
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Name / Phone / Fax
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Account Number / Expiration Date
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Signature / Date
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Please PRINT name EXACTLY as it should appear in all printed materials