Area 6 Golf Outing & Trap Shoot Registration & Sponsorship Form

McKillip Farm: 9 am

1017 County Rd. 1350th N, Lerna, IL 62440

Meadowview Golf Course: 1 pm (shotgun start)

6489 Meadowview Lane, Mattoon, IL 61938

Contact Name

First NameLast Name

Company Name

E-mail

example@example.com

Contact Number

Format: (000) 000-0000.

Payment Method

Are you sponsoring at this event?

Sponsorship Opportunities:

Logo for signage

Are you registering for golf and/or the trap shoot?

Are you bringing a "Gopher It" invite?

"Gopher It" Registration

NamePhoneEmail

"Gopher It" Registration

Registrant 1

Registrant 2

Registrant 3

Registrant 4

My preferred foursome Is

Leave blank if you do not have a preference

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

USDIncludes 4% convenience fee