Primary Company Sponsor _____________________________________

1. THE 6th ANNUAL VPPPA Region VII Scholarship Golf Tournament May 6, 2013 Shot Gun Start 8:00 am REGISTRATION FORM Tiffany Greens Golf Course 5900 NW Tiffany Springs Parkway; Kansas City, MO (816) 880-9600 http://www.tiffanygreensgolf.com/ • Method of Payment (check appropriate box) • Check Payable to: • VPPPA Region VII • Scholarship Golf Tournament • Credit Card •  MasterCard  Visa •  American Express • ______________________________________ • Card Number • __________________________________________ • Cardholder Name (print) • ____________________________________ • Expiration Date • _______________________________________ • Cardholder Signature Primary Company Sponsor _____________________________________ Address _____________________________________________________ City/State/Zip _________________________________________________ E-Mail Address _______________________________________________ Daytime Phone ____________________________________________ Golfer Name : 1.___________________________________________________ 2. ___________________________________________________ 3. ___________________________________________________ 4. ___________________________________________________ YES I would like to play but need help with a team $75 per player or $300 per team • We hope you will be able to select one of the sponsorship • contribution options. •  YES I would like to Sponsor • Check Sponsorship Level • Master Sponsor $400 Open Sponsor $200 • 4 Golfers 2 Golfers • 2 Tee Signs 1 Tee Sign • Hole Sponsor $125 Tee Sponsor $50 • 1 Golfer 1 Tee Sign • 1 Tee Sign •  I am unable to play, but enclosed is a donation for the VPPPA Region VII Scholarship Fund in the amount of $______________. • Total Registration fees $___________________ • If paying by check, completed registration form with check should be mailed by April 23, 2013 to: • VPPPA Region VII Address • If paying by credit card, completed registration form, along with credit card information requested above, should be sent by April 23, 2013 to: • Carlena Ford • Phone: (703) 761-1146 ext. 304 • Fax: (703) 761-2194 • Email: cford@vpppa.org The VPPPA Region VII is a 501 (c) (3) non-profit organization.