The Valley Hospital Auxiliary's 49th Annual Golf Outing

Guest Information:

• If, besides yourself, you have additional guest(s) or golfer(s) in your registration, we require each person's full name and email to complete your registration. Please type their information in the box below your information. If you are not sure of your additional golfer/guest(s) as yet, please provide their information as soon as you have it available to bdalal@valleyhealth.com.

Personal Information of Primary Registrant

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• Address 1:
• Address 2:
• City:
• State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• ZIP Code:
• Cell Phone:
• Enter your additional golfer/guest full names and emails:
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• Indicate if there are any single person golf carts requested by any of the golfers in your group. If so, provide the name of the golfer(s).

Business Name as it should appear in advertising signage

• Company:
• Address 1:
• Address 2:
• City:
• State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• ZIP Code:
• Phone:
• Business Email:

Platinum and Gold Sponsor Advertising Choice and other Questions?

• Platinum and Gold Sponsors: Please enter your advertising choice here. For example, as a Platinum sponsor you can have your company name as a lunch, dinner or golf carts sponsor. Gold sponsorships can have their company name on the putting green, driving range or valet parking. You are also welcome to enter any additional questions or comments for the event organizer in this space.
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• Donations are tax-deductible to the extent allowable by law. Information files with the Attorney General concerning this charitable solicitation and the percentage of contributions received by the charity during the last reporting period that were dedicated to the charitable purpose may be obtained from the Attorney General pf the State of New Jersey by calling 973-504-6215 and is available on the internet at www.state.nj.us/lps/ca/charfrm.htm. Registration with the Attorney General does not imply endorsement.