Annual Golf Tournament Ticket Purchase

Ticket Purchase
I wish to support the 23rd Annual Lakeshore General Hospital Foundation’s Golf Tournament.
* A portion of your ticket purchases is eligible for a tax deduction *
I wish to purchase:*
(please select one)
- Gold Sponsorship @ $10,000 (includes 1 foursomes)
- Silver Sponsorship @ $5,000 (includes 1 foursome)
- Bronze Sponsorship @ $3,500 (includes 1 foursome)
- Yes, I will attend and wish to reserve foursome(s) @ $2,500
- Yes, I will attend and wish to reserve for single golfer(s) @ $625
- I would like to reserve ticket(s) the Cocktail Dînatoire only @ $150
- I am unable to attend but would like to donate instead
Gold Silver Bronze Foursome
Please enter the names of your golfers*
First Name Last Name
Foursome Reservation:*
Each foursome costs $2,500.
Price: $ 0.00 CAD
Enter the number of foursomes you would like to reserve.*
Please enter a number from 1 to 10.
Foursome
Please enter the names of your golfers*
First Name Last Name
Single Ticket Reservation:*
Each ticket costs $625 per person.
Price: $ 0.00 CAD
Please enter the number of tickets you would like to reserve.*
Please enter a number from 1 to 10.
Please enter the names of your golfers*
First Name Last Name
Dinner Ticket Reservation:*
Each ticket costs $150 per person.
Price: $ 0.00 CAD
Please enter the number of dinner tickets you would like to reserve.*
Please enter a number from 1 to 10.
Please enter your donation amount:*
Total Price:
$ 0.00 CAD
*If you choose to sponsor our golf tournament, Alison Harris will contact you shortly to coordinate the details of your sponsorship.

CONTACT INFORMATION
Name*
First Last
Company Name
Company Name
Address*
Street Address Address Line 2 City Province Postal Code
Telephone*
Email*

PAYMENT METHOD
Would you like a tax receipt?*
- Yes
- No, I prefer to remain anonymous
Credit Card Payment
Billing Information*
Same address

Street Address Address Line 2 City Province Postal Code
Credit Card Information*

American Express
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Summary
**Please confirm that all information is correct.**
Name: {Name (First):1.3} {Name (Last):1.6}
Company Name: {Company Name (First):89.3}
Address: {Address (Street Address):2.1}, {Address (City):2.3}
{Address (State / Province):2.4} {Address (ZIP / Postal Code):2.5}
Telephone: {Telephone:3}
Email: {Email:4}

Golf Options
Choices: {I wish to purchase::100}
Quantity of foursomes: {Enter the number of foursomes you would like to reserve.:78}
Quantity of single tickets: {Please enter the number of tickets you would like to reserve.:79}
Quantity of dinner tickets: {Please enter the number of dinner tickets you would like to reserve.:82}
Donation amount for those who cannot attend: {Please enter your donation amount::87}
Total: {Total Price::69}
Total
$ 0.00 CAD
Captcha
Name
This field is for validation purposes and should be left unchanged.

First Name	Last Name

First Name	Last Name

First Name	Last Name

Ticket Purchase

CONTACT INFORMATION

PAYMENT METHOD

Credit Card Payment

Summary

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