Anadem Optometry Golf Outing
March 19 Golf Club of Akron Ohio
Name *
Player Name
Phone
Handicap
Company
Address
City
State
Zip (Please enter only numbers for Phone, Fax and Zip)
Phone *
Fax
E-maill *
 
I will be playing one round of golf: I will be playing two rounds of golf:
Number of Players        X $99  =  $ Number of Players        X $199  =  $
Number of Foursomes X $399  =  $ Number of Foursomes X $799  =  $
Please specify if you will be golfing in the morning or afternoon  Morning Golf                        Afternoon Golf
I will be donating an auction/raffle item                        I want to be a sponsor:
                                                                                                                                    Platinum: $10,000
                                                                                                                                    Gold: $5,000
                                                                                                                                    Silver: $2,500
                                                                                                                                    Bronze: $1,000
                                                                                                                                    Hole Sponsor: $500
Payment Details
Please bill my  credit card * Total Amount $
Credit Card # *  
Expiration Date *  
Please direct any questions to the Anadem:

Anadem Publishing, Inc.  3620 N. High Street, Suite 201 Columbus, OH 43214
Ph: (800) 633-0055 - Fax: (614) 262-6630 e-mail: anadem@anadem.com