Golf Tournament Registration Form

22nd Annual Golf Tournament Registration Form

Monday, April 28th, 2025 | 12:30 PM Start | West Orange Country Club
Team Information

Please provide information about the team that will be sponsoring the tournament.
Company Name*
Contact Name*
Phone*
E Mail*
Address*
City*
State*
Zip*
Player Information

Please list the players who will be joining us and the sponsorship level you'd like to choose. A detailed listing of sponsorship levels can be found at www.chcfl.org/golf
Player #1
Player #2
Player #3
Player #4
Sponsorship Level*

Presenting - $10,000Healthcare Supporter - $7,500Lunch & Awards Dinner - $6,500Eagle - $5,000Birdie - $2,500Corporate - $1,000Hole - $300
Add on a Hole sponsorship for only $300 per hole?

Yes, please!No thank you.
How many extra holes would you like to sponsor? (Max 10)
Payment Information

Your sponsorship will benefit the Community Health Centers patients all throughout Central Florida. We appreciate your generous support over the years.
Payment Method*

CheckAMEXMCVisaDiscover
After submission of this form, please mail payment to:

Community Health Centers, Inc.
Development Department
110 S Woodland St
Winter Garden, FL 34787

Questions? Contact

407-905-8827, x1050
j.riordan@chcfl.org
Card Number*
Name*
Expiration Date*
Security Code*
Sponsorship Total
Signature*

Clear
Community Health Centers, Inc. is a Non-Profit 501(c)(3) Healthcare Organization. Our Tax ID Number is 59-1480970

A copy of the official registration and financial information May be obtained from the division of consumer services by calling toll-free (800-435-7352) Within the state. Registration does not imply endorsement, approval, or recommendation by the state.
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22nd Annual Golf Tournament Registration Form

Team Information

Player Information

Payment Information