The Dave Wolkins 21st Annual Golf Outing Classic - Player/Sponsorship Registration

Please fill out this form to play in or be a sponsor for Representative Dave Wolkin's annual Golf Outing scheduled on Monday September 13, 2010 at Stonehenge Golf Club in Warsaw, Indiana and click on the submit button at the bottom of the page. The event will begin with lunch at 11:00 and a shotgun start at 11:45 am.

$200 per player or

$700 per foursome

Thank you for your support.

Directions from Indianapolis - Fort Wayne - Gary - Lafayette - or Evansville

If you have any questions, please contact Blake Jeffery at 317/974-1830 or Rep. Wolkins at 574-551-9574.

Please provide the following Player 1/billing contact information:

 First/Last Name 
    Organization 
  Street Address 
 Address (cont.) 
            City 
  State/Province 
 Zip/Postal Code 
      Work Phone 
	   Email

Please provide the following Player 2 information:
```
 First/Last Name 
    Organization 
```
Please provide the following Player 3 information:
```
 First/Last Name 
    Organization 
```
Please provide the following Player 4 information:
```
 First/Last Name 
    Organization 
```
Would you like to be a sponsor?
Yes No
How would you like for your company name to read on the sponsorship publicity?
```
 Company Name 
```
Sponsorship preferred?
Gold Event Sponsor - $1,000 (includes 2 player registrations)

                        Special Thanks to Our Gold Sponsors to Date:

                                          Duke Energy
                                          Indiana Statewide Association of Rural Electric Cooperatives

Drink Cart Sponsor - $350

Reception Sponsor - $200

Luncheon Sponsor - $350

Longest Drive for Men Sponsor

~~Putting Green Sponsor~~ - Already taken by

                                                the Independent Insurance Agents of Indiana $250

Longest Drive for Women Sponsor - $175

Closest to the Pin - $175

Longest Putt - $175

Hole sponsor - $100

        Hole Sponsors to Date:

Please make checks payable to "Citizens for Wolkins" and bring payment to the outing or mail to:

Citizens for Wolkins

PO Box 891

Warsaw, IN 46581
.
$200 per player
$700 per foursome

Thank you for your participation and support!