Contact Name
*
First Name
Last Name
Company Name
*
E-mail
*
example@example.com
Contact Number
*
Are you sponsoring at this event?
*
Yes
No
Sponsorship Opportunities:
*
Beverage Cart Sponsor $250
Lunch Sponsor $250
Dinner Sponsor $350
Event Sponsor $500: Receive buy 3, get 1 FREE golf & dinner registration
Green or Tee Sponsor $150
Longest Drive Prize Sponsor (unavailable)
Closest to the Pin Prize Sponsor (unavailable)
Longest Put Prize Sponsor (unavailable)
Lowest Scoring Team Prize Sponsor $200
Green or Tee Sponsor sign
Please Select
Please use last years sign
We will provide a sign (16" x 24")
Please make us a new sign $35
Are you registering for golf and/or the trap shoot?
*
Yes
No
Are you bringing a "Gopher It" invite?
*
Yes
No
"Gopher It" Registration
Name
Phone
Email
"Gopher It" Registration
Please Select
Golf Only (free)
Golf & Dinner (free)
Trap, Golf, & Dinner (free)
Trap Only (free)
Dinner Only (free)
Registrant 1
Registrant 1
*
Please Select
Golf Only $55
Golf & Dinner $80
Trap, Golf, & Dinner $90
Trap Only $15
Dinner Only $40
Registrant 2
Registrant 2
*
Please Select
Golf Only $55
Golf & Dinner $80
Trap, Golf, & Dinner $90
Trap Only $15
Dinner Only $40
Registrant 3
Registrant 3
*
Please Select
Golf Only $55
Golf & Dinner $80
Trap, Golf, & Dinner $90
Trap Only $15
Dinner Only $40
Registrant 4
Registrant 4
*
Please Select
Golf Only $55
Golf & Dinner $80
Trap, Golf, & Dinner $90
Trap Only $15
Dinner Only $40
My preferred foursome Is
Leave blank if you do not have a preference
Payment Method
*
Credit Card (4% convenience fee applies)
Send Check
Registration total (used for discount purpose only)
Please mail a check for the total amount to Illinois LICA, 112 Exchange St., Suite 2, Galva, IL 61434
Calculation
Total
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next
( X )
USD
Includes 4% convenience fee
Credit Card
Register
Should be Empty: