SPONSORSHIP FORM

Date

Name of Sponsor

Email

example@example.com

Name of Contact Person

Email

example@example.com

Address/ City/ State/ ZIP

Office Phone

Format: (000) 000-0000.

Cell Phone

Format: (000) 000-0000.

Sponsor’s Name exactly as it should appear in all event publications

Sponsorships Available

Get ahead of the game and pre-purchase your boost and mulligan pack! Boosts can be used to make an activity easier and Mulligans allow you to skip an activity.

I AM UNABLE TO ATTEND, BUT WISH TO MAKE A CONTRIBUTION IN THE AMOUNT OF:

Donations $100 and above will be recognized in the event program. Payment is requested by 04/03/2026.

Billing and Payment Information

Calculation

Amount to be Charged

USDDescription

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Card Type

I hereby authorize PediPlace to charge my credit card in the amount of ${calculation}.

Please return completed underwriting contract by April 3, 2026 to:

PediPlace Attn: Shari Markey 502 S. Old Orchard Lane #126 Lewisville, TX 75067

shari.markey@pediplace.org

469-322-3660

Your contribution is tax deductible to the extent allowable by law. PediPlace sincerely thanks you for your support.