Personal Information:

Name

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Company

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Address

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City

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State
----------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
Please select a state.

Zip Code

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Phone Number

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Cell Phone

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E-mail* (E-mail address is required to submit form.)

Sponsorship Levels:
General Sponsor ($3,500)............................Quantity ---- (x1) (x2) (x3)
Colonel Sponsor (2,500)..............................Quantity ---- (x1) (x2) (x3)
Awards Sponsor ($1,000)............................Quantity ---- (x1) (x2) (x3)
Cart Sponsor ($1,000 one available)
Beverage Sponsor ($500)............................Quantity ---- (x1) (x2) (x3)
Driving Range Sponsor ($500).....................Quantity ---- (x1) (x2) (x3)
Major (Hole) Sponsor ($250).......................Quantity ---- (x1) (x2) (x3)
Golfer ($250)...............................................Quantity ---- (x1) (x2) (x3) (x4) (x5) (x6) (x7) (x8)
Dinner Only ($60).......................................Quantity ---- (x1) (x2) (x3) (x4) (x5) (x6) (x7) (x8)

I would like to donate an auction item.     Donation Item

(If you would like to donate an auction item, please call Theresa at (414) 365-8900 ext. 320.)

I am unable to attend, but please accept my donation of $

Payment Method ---------- Check MasterCard Visa

If you select a payment method other than check, Theresa Deuel will
contact you shortly to arrange your payment method of choice.

If you selected Check for your method of payment,
please make check payable to Fisher House – Benefit Golf.

Address the check to:

        Attn: Theresa Deuel – FHBG
        Fisher House – Wisconsin
        9401 W. Brown Deer Road
        Milwaukee, WI 53224

Foursome Information
(If you do not have a full foursome, we will fill your group.)

Foursome 1
(Name, Full Address, Phone Number, and E-mail of each golfer)

Foursome 2
(Name, Full Address, Phone Number, and E-mail of each golfer)

Dinner Guests (Please list names of all guests attending dinner.)

Total Number of Golfers & Guests Staying for Dinner

I hereby attest that the information that I have provided is true to the best of my knowledge.
Please make a selection.

Enter Security Code:

After you click the Submit Registration Form Button, a thank you window should pop up
if the form was actually submitted. If the form does not submit, you will be redirected to a
window that states, "An error occurred and your registry information was not submitted."
If you receive the error window, we sincerely appologize for the inconvinience and you
may have to resubmit the form.