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Golfer and Sponsor Registration Form

Yes! I want to support the 35th Annual Ralph P. DeStephano Memorial Golf Classic Tournament on September 8, 2014 (click on the sponsorship level for a detailed explanation of what's included):

Sponsorship Levels Amount
  Presenting/Title Sponsor  RESERVED
  Diamond/Tee Prize Sponsor  RESERVED
  Platinum/Cart Sponsor  RESERVED
Gold/Dinner Sponsor  $7,500
Silver/Rules Sheet Sponsor  $5,000
19th Hole/Lunch Sponsor  $3,500
Bronze Sponsor  $2,500
Blue Sponsor  $1,750
Closest to the Pin Contest  $1,500
Longest Drive Contest  $1,500
Driving Range Sponsorship  $750
Hole/Tee Sponsors  $500
Individual Golfer  $425
Friend of Unity Health System  $250
  Additional Dinner Tickets: $75.00 each

The format is a four-person scramble with a two-putt rule. We encourage you to form your own foursomes. Registration and club location will be confirmed once payment is received. Choice of country club is on a first-come, first-served basis.

* indicates required fields.

Contact Name*
Company Name*
Daytime Phone*
Company Web Site
Reminder - Bronze through Title may golf at any of the four golf locations.
Blue through Individual golfers may golf at Ridgemont, Brook-Lea. Please refer to tournament schedule for locations and times.
Course preference
(please select one)
Please fill in names of golfers for your foursome:
Total Due*
Credit Card #*
Exp. Date*
Name on Card*
Security Code* (Last 3 digits on back of card)
The Unity Health System Foundation is a 501 (c) (3) charitable organization that raises philanthropic support for Unity Health System. As such, any gift amount above $180 per golfer, is tax deductible to the fullest extent under the law.

Unity Health Foundation annual reports may be obtained by writing to Unity Health Foundation: 1555 Long Pond Road, Rochester, New York 14626 or the office of Charities Registration, Department of State, 162 Washington Avenue, Albany, New York 12231.