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2012 IERC Golf Registration Form

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Jacob Stuart
Jacob Stuart

The document announces a golf outing fundraiser for the 2012 Indiana Emergency Response Conference (IERC) to be held on September 12th at the Winding River Golf Course. A four-person scramble tournament will have an 8am shotgun start with the cost being $60 per person or $240 per foursome. Sponsorship opportunities include hole sponsors for $125, hole sponsors and a foursome for $340, and cart sponsors for $25. Prizes will be awarded for first, second, and third place teams as well as for longest drive and closest to pin. The registration deadline is September 8th.

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2012 INDIANA EMERGENCY RESPONSE 2012 IERC Golf Outing Wednesday, September 12, 2012 Winding River Golf Course 8015 South Mann Rd Four Person Scramble - 8:00 am Shotgun Start Indianapolis, IN 46221 Cost: $ 60 per person for Green Fees & Lunch $ 240 for a Foursome www.windingrivergc.com Hole Sponsors: Hole Sponsors: $ 125 Hole Sponsors and a Foursome: $ 340 Cart Sponsor $25 Your Sponsor signage on one of the golf carts Prizes: 1st, 2nd, 3rd Place, Longest Drive, & Closest to Pin Title Sponsor Lunch Sponsor Fire, EMS, Law Enforcement, Exhibitors and Spouses are cordially invited to attend. Participants wishing to play the day before (9/12/12) should contact the golf course directly at 317-856-7257. Breakfast Sponsor Registration Participant Type Quantity Cost Total Foursome Deadline: 9/08/12 Single Participant $60 $ Sponsorship Deadline: 9/08/12 Foursome $240 $ *Sponsor Name (for signage) Cart Sponsor* $25 $ ____________________________________ Hole Sponsor* $125 $ Hole Sponsor + Foursome* $340 $ ____________________________________ Total $ *Sponsors, please email your company logo (in high-resolution jpeg or esp format) for signage to rake@indfirechiefs.org Participant(s) Information and Payment (Print Legibly Please) Name(s) 1. ____________________ Handicap ______ 2. ____________________ Handicap ______ 3. ____________________ Handicap ______ 4. ____________________ Handicap ______ Fire Dept./Company ________________________________ Address ______________________________________________________ Phone/Email _______________________________ / _____________________________________________________________ Return this form with payment (check - payable to IFCA) to: 2012 IERC Golf Outing, P.O. Box 364, Zionsville, IN 46077 PH (317) 733-1850, Fax (317) 733-4212, Email: rake@indfirechiefs.org. Team Coordinator: Chief Dale Henson of the Decatur Township Fire Department. Please send a copy of this form to: Chief Henson at Decatur Township Fire Department, 5410 S. High School Road, Indianapolis, IN 46221 Ph (317) 856-5400, Fax (317) 856-1426, Email dhenson@decaturfire.org. Payment: ___ Check Enclosed ___ Visa ___ MC CC # ______________________________________ Exp ______ Name on Card _______________________________Signature _________________________________ indianaerc.com •September 12—15 • Downtown Indianapolis

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2012 IERC Golf Registration Form

  • 1. 2012 INDIANA EMERGENCY RESPONSE 2012 IERC Golf Outing Wednesday, September 12, 2012 Winding River Golf Course 8015 South Mann Rd Four Person Scramble - 8:00 am Shotgun Start Indianapolis, IN 46221 Cost: $ 60 per person for Green Fees & Lunch $ 240 for a Foursome www.windingrivergc.com Hole Sponsors: Hole Sponsors: $ 125 Hole Sponsors and a Foursome: $ 340 Cart Sponsor $25 Your Sponsor signage on one of the golf carts Prizes: 1st, 2nd, 3rd Place, Longest Drive, & Closest to Pin Title Sponsor Lunch Sponsor Fire, EMS, Law Enforcement, Exhibitors and Spouses are cordially invited to attend. Participants wishing to play the day before (9/12/12) should contact the golf course directly at 317-856-7257. Breakfast Sponsor Registration Participant Type Quantity Cost Total Foursome Deadline: 9/08/12 Single Participant $60 $ Sponsorship Deadline: 9/08/12 Foursome $240 $ *Sponsor Name (for signage) Cart Sponsor* $25 $ ____________________________________ Hole Sponsor* $125 $ Hole Sponsor + Foursome* $340 $ ____________________________________ Total $ *Sponsors, please email your company logo (in high-resolution jpeg or esp format) for signage to rake@indfirechiefs.org Participant(s) Information and Payment (Print Legibly Please) Name(s) 1. ____________________ Handicap ______ 2. ____________________ Handicap ______ 3. ____________________ Handicap ______ 4. ____________________ Handicap ______ Fire Dept./Company ________________________________ Address ______________________________________________________ Phone/Email _______________________________ / _____________________________________________________________ Return this form with payment (check - payable to IFCA) to: 2012 IERC Golf Outing, P.O. Box 364, Zionsville, IN 46077 PH (317) 733-1850, Fax (317) 733-4212, Email: rake@indfirechiefs.org. Team Coordinator: Chief Dale Henson of the Decatur Township Fire Department. Please send a copy of this form to: Chief Henson at Decatur Township Fire Department, 5410 S. High School Road, Indianapolis, IN 46221 Ph (317) 856-5400, Fax (317) 856-1426, Email dhenson@decaturfire.org. Payment: ___ Check Enclosed ___ Visa ___ MC CC # ______________________________________ Exp ______ Name on Card _______________________________Signature _________________________________ indianaerc.com •September 12—15 • Downtown Indianapolis