To register for the Golf Tournament:

Click "Download File" below to print registration form

If paying by check: Submit check with the registration form and mail to:
Paul Valove, M.D.
4 Old Granary Court
Catonsville, MD 21228

If paying by credit card: Download and complete registration form and mail to address above.
Complete credit card payment by clicking link below:

$25,000 TITLE SPONSOR
- NAMING RIGHTS
- PRODUCT DISPLAY ON COURSE
- AD IN PROGRAM
- HOLE SIGNAGE
- 4 TOURNAMENT PLAYERS


$10,000 PRODUCT SPONSOR
- PRODUCT DISPLAY
- PROGRAM AD
- HOLE SIGNAGE
- 4 TOURNAMENT PLAYERS


$5,000 TEAM SPONSOR
- AD IN PROGRAM
- HOLE SIGNAGE
- 4 TOURNAMENT PLAYERS


$1,000 HOLE SPONSOR
- HOLE SIGNAGE
- AD IN PROGRAM
- 1 TOURNAMENT PLAYER

The 2nd Annual Ethan's H.O.P.E. (Help Overcome Pediatric Epilepsy) Celebrity Golf Classic

REGISTRATION FORM


NAME: _________________________________


COMPANY: _________________________________


ADDRESS:__________________________________________________________________


CITY:_________________________________


STATE:_________________________________


ZIP:_________________________________


PHONE:_________________________________


EMAIL:_________________________________


 I AM REGISTERING FOR (CHECK ALL THAT APPLY):


_____$1200.00 - 3 PLAYERS + 1 CELEBRITY


_____$1200.00 - TEAM OF 4 PLAYERS


_____$325.00 - INDIVIDUAL PLAYER


_____$150.00 - GUEST: LUNCH, RECEPTION AND SPECIAL EVENTS


_____SPONSORSHIP $______________


_____ $25.00 - DISCOUNT IF PAID BY 12/31/09


NAME OF PARTICIPANT(S) AND HANDICAP: PLEASE PRINT CLEARLY

 1.______________________________________


2.______________________________________


3.______________________________________


4.______________________________________


 TOTAL AMOUNT PAID:

TEAM ENTRY $_________________

 INDIVIDUAL(S) $_________________

 SPONSORSHIP$_________________


PAYMENT INFORMATION

PLEASE MAKE CHECK PAYABLE TO: KENNEDY-KRIEGER INSTITUTE

AND MAIL CHECK AND REGISTRATION FORM TO:

PAUL VALOVE, M.D.

4 OLD GRANARY COURT

CATONSVILLE, MD 21228


_____ CLICK HERE IF PAYING BY CREDIT CARD AT www.support.kennedykrieger.org/ethanshope