Primary Contact First Name

Primary Contact Last Name

Primary Contact Phone Number

Primary Contact E-Mail Address

Sponsorship Level

- Select -Scoreboard Level - $800 (4 Players) Gold Level - $700 (4 Players)

Team Sponsor Name - To be listed in recognition materials

Billing Address

City

State

Zip Code

Game Package ($40): Each player receives 3 chips for Golf Pong

- Select -YesNo

1Golf Ball Raffle- $20 (Yes/No)

- Select -YesNo

Is your business interested in donating a Flag Prize?

- Select - Yes No

Payment Option (Please use your confirmation email as an invoice)

- Select - Pay via Credit Card by calling Heartland United Way at (308) 382-2675 Pay via check sending to Heartland United Way, 1441 N Webb Road, Grand Island, NE 68803

Player Information

First Name

Last Name

E-mail Address

Phone Number

First Name

Last Name

E-mail Address

Phone Number

First Name

Last Name

E-mail Address

Phone Number

First Name

Last Name

E-mail Address

Phone Number

Team Photo Release

(security question) What color is the sky?

Submit

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