Genesis Pro-Am Challenge
August 18, 2014
Pro Sign-Up Sheet
___ I am committing to participate in the Genesis Pro-Am Challenge on August 18, 2014.
Course Preference:
TPC ___
Crow Valley ___
(We will try our best to place you in a foursome at your Course of preference.)
Rain Dates: September 15, 2014 for Crow. There is NOT a rain date set for TPC.
___ I'm giving the Foundation approval to communicate with me via email.
___ I am committing to participate, if necessary, on the rain date that corresponds to the Club of
choice.
___ I will attend the Awards Reception at the end of the day.
___ I am committing to donating a round of golf for four at my club.
(Please mail gift certificate with this form.)
___ I will make a donation of items to be given away as prizes during the Reception and Awards
Ceremony. (Please bring items to the Club Pro Shop when checking in.)
List of Items:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Name ______________________________________________________________________
Club _______________________________________________________________________
Club Address _________________________ City/St/Zip ______________________________
Email Address _______________________________________________________________
Phone Number_____________________________ Cell Phone ________________________
Please provide your social security number in order to receive the appearance fee of
$200 ______________________________. A check will be mailed to you after the
tournament.
Home Address _______________________________________________________________
City __________________________ State ___________ Zip Code _____________________
Questions? Please call Deb at (563) 421-6861, fax to 563-421-6869 OR email
hughes@genesishealth.com.
Thank you!