Family House Golf Outing
Sponsorship Commitment Form
Monday, May 19, 2008
Country Club of Peoria

Every Foursome plays with a Club Pro! Family House invites you to join us for an afternoon of golf in support of our efforts to serve the community as the area’s only hospital hospitality house, providing a “home away from home” for families receiving medical care in Peoria.

Company Name:____________________________________________________________

Contact Person:_____________________________________________________________

Address:____________________________________________________________________

Phone:________________  Fax:_________________   Email:_____________________

Sponsorship Options - Please select the category of your choice:   q       Platinum Sponsorship (limit of one) - $5,000 q       Luncheon Sponsorship - $2,500 q       Awards Ceremony Sponsorship - $2,500 q       Carts Sponsorship - $2,500 (SOLD) q       Beverages Sponsorship - $2,500 or In-Kind q       Gold Sponsorship - $1,250 q       Foursome Sponsorship - $1,000 q       Driving Range or Putting Green Sponsorship (Please specify) - $500 q       Hole Sponsorship - $100 q      Additional Golfers - $250 each, please note number requested: ____

Names of Golfers:

________________________________	________________________________
________________________________	_________________________________

Method of Payment: 

	Check Enclosed		Please Invoice
	Credit Card:		Visa		Master Card
Credit Card Number: ____________________________________ Exp: _______________
Signature:_________________________________________________________________
Please return this form by fax or mail to:			Family House 1509 N. Knoxville Ave. Peoria, IL 61603 Fax (309) 688-8324 Phone (309) 685-5300