Welcome to the Bill Kelly Jr. Memorial Fund

Contact Information

First Name:
Last Name:
Company:
Address:
City:
State:
Zip / Postal Code
Phone Number:
Mobile Phone Number
Email Address:
Retype Your Email Address:

Golfer Registration

	I would only like to register myself - $175
	I would like to register a two person team - $350
	I would like to register a three person team - $525
	I would like to register a foursome - $700
	Sponsorship-only (pick a sponsor level below)

Sponsorship Package

	Hole-in-One - $1,500
	Double Eagle - $1,000
	Eagle - $500
	Birdie - $250
	None

Dinner-Only Guests Dinner (Non-golfer) $50.00 - Dinner for non-Golfer

Honorary Donation Please consider a charitable donation to help us support the Bill Kelly, Jr. ('93) Memorial Scholarship at the University of Scranton.
$

Golf Course Preference Please select which course you'd like to play at

Participation If this order is for participation/registration ONLY, please select one of the following options:

	I am both a participant AND billing contact
	I am the billing contact ONLY, and I am NOT participating

Additional Comments