Yes! I/we would like to play in the Golf Tournament.

Foursome ($900)Individual Golfer ($225 each)

Yes! I/we would like to support the Golf Tournament.

Lead Sponsor-ReservedEvent Partner $2,500Supporting Sponsor $1,500Hole Sponsor $400Gift Bag Contributor 200 ct.Auction Item Donation (Specify)

Contact Information

Company Name:

Contact Person:

Contact Email:

Contact Phone Number:

Payment Information

Total Amount $

Please make all cheques payable to:

West Haldimand Hospital and Healthcare Foundation
75 Parkview Rd.
Hagersville ON N0A 1H0

VISA or MASTERCARD is Accepted
or call Lisa Hostein at 905-768-3311 ext. 1236

I will call the Foundation office to provide payment by credit cardI will send a cheque to the Foundation

Golfer Information

Golfer #1 Name:

Address:

City:

Postal Code:

Phone:

Email:

Golfer #2 Name:

Address:

City:

Postal Code:

Phone:

Email:

Golfer #3 Name:

Address:

City:

Postal Code:

Phone:

Email:

Golfer #4 Name:

Address:

City:

Postal Code:

Phone:

Email:

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