Sponsorship Confirmation Form

Company or Name:
Please list the way you wish to be recognized, if different from company name:
First Name:	Last Name:
Title:
Address:
City:	State:	Zip:
Phone:	Fax:
Email:

Sponsorship Level: (Your total contribution will determine benefits and sponsor levels)   $20,000 - Event Sponsor $15,000 - Platinum Sponsor $12,000 - Player Shirt Sponsor $10,000 - Gold Sponsor $5,000 - Signature Item Sponsor $2,500 - Double Eagle Sponsor $1,000 - Eagle Sponsor $800 - Birdie Sponsor $500 - Par Sponsor $300 - Hole Sponsor Under $300 - Contributors In Kind Sponsor

Please make checks payable to: Wuesthoff Health System Foundation Mail Stop #18 P. O. Box 565002 Rockledge, FL 32956-5002 Phone: 321-637-2606 Fax 321-690-6621

© 2008 Wuesthoff Health System. All rights reserved.