Choose a Sponsorship Level:
*
Tee: >$100
Par: $100 - $399
Birdie: $400-$499
Eagle: $500 - $749
Albatross: $750 - $999
Condor: $1,000+
Name of Business or Individual Contributing
*
Description of Item You Would Like to Donate:
*
Value of the Donation:
*
Email
*
Email is collected to send a confirmation
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you Registering a Team of 4?
Yes
No
Team Members:
If registering a team, please list first and last names of each team member
Logo to be used for website & signs
Browse Files
Drag and drop files here
Choose a file
Alternately you can email the logo to info@waterburyambulance.org
Cancel
of
Submit
Should be Empty: