heads up! eighth annual - uw health
TRANSCRIPT
a go
lf ou
t ing
to ce
lebra
te and honor the courage of those affec ted by head and neck c ancer
heads up!
J o i n u s ! • M o n d a y • J u l y 2 1 • 2 0 1 4
un i ve r s i t y r i dge go l f c ou r s e • 9002 Coun ty Road PD ve rona , w i s c on s i n
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R e g i s t r a t i o n F o r m
PARTICIPANTS:
Golfer #1 Name ____________________________________________________________
Address __________________________________________________________________
City______________________________________State _________ Zip _______________
Golfer #2 Name ____________________________________________________________
Address __________________________________________________________________
City______________________________________State _________ Zip _______________
Golfer #3 Name ____________________________________________________________
Address __________________________________________________________________
City______________________________________State _________ Zip _______________
Golfer #4 Name ____________________________________________________________
Address __________________________________________________________________
City______________________________________State _________ Zip _______________
Participating in honor or memory of:
________________________________________________________________________
________________________________________________________________________
Please return completed form and payment to: University of Wisconsin FoundationAttn: Donna Kelley1848 University AvenueMadison, WI 53726
Or register online: uwhealth.org/headsup
Questions?Contact Reena Chandra Rajpal(608) 265-6119 or [email protected]
uwhealth.org/headsup
eighth annual
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Proceeds to benefit head and neck cancer research and services in Human Oncology
and Otolaryngology and UW Carbone Cancer Center
R e g i s t r a t i o n F o r m
Please respond by July 1, 2014
name
address
city state zip
phone
company
Standard Fee:
_____ Golf foursome, lunch and dinner included @ $800 ($300 tax deductible) $ ______________
_____ Single golfer, lunch and dinner included @ $200 ($75 tax deductible) $ ______________
_____ Dinner only @ $25 ($5 tax deductible) $ ______________
For Head and Neck Cancer Patients & Immediate Family Members:
_____ Golf foursome (lunch and dinner included) @ $200 $ ______________
_____ Single golfer (lunch and dinner included) @ $50 $ ______________
_____ Dinner only @ $25 ($5 tax deductible) $ ______________
Donation:
I/We would like to make an additional contribution toward
head and neck cancer research at the UW Carbone Cancer Center. $ ______________
Regrets:
I/We are unable to attend, but would like to contribute toward
head and neck cancer research at the UW Carbone Cancer Center. $ ______________
TOTAL: $ ______________
Payment:
check enclosed (payable to University of Wisconsin Foundation, please include on memo line: Fund #12587056)
visa mastercard expiration date _______________
account
cardholder’s name
cardholder’s signatureparticipant information and mailing address on back
More than 55,000 people will be diagnosed with head, neck or oral cancer this year.
Please join us to honor the courage of those affected by head and neck cancer and in support
of head and neck cancer research.
Thank you for your support!
SCHEDULE 10:30 am Golf registration with box lunch 12:00 pm Golf, shot-gun start (scramble format) 5:30 pm Cookout, followed by recognition program
COST (standard fee):$800 golf foursome
(lunch and dinner provided) $200 per person
(lunch and dinner provided)$25 dinner only
Through generous donors, we are able to offer this special fee for head and neck cancer patients and their immediate family members:
$200 golf foursome (lunch and dinner provided)
$50 per person (lunch and dinner provided)
$25 dinner only
Tournament will be held rain or shine
PLEASE NOTE:Honor a patient, health care provider, or simply the Head and Neck Cancer Research Program by making a designation
when you register. Your designation will be displayed on golf carts during the event and on nametags.
Keynote Speak
er: U
W B
adge
r Men
’s Basketbal l Coach Bo Ryan
Join us for the 8th Annual Heads Up! Golf Outing
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