Lung Cancer Golf Classic In Buies Creek Keith Hills Golf Club 216 Country Club Drive Buies Creek, NC The 6th Annual Lung Cancer Golf Classic in Buies Creek, established in memory of Thom Wood, provides an opportunity for lung cancer advocates, survivors and the community to come together to raise awareness and support to fight this disease. The net proceeds from this event will benefit the Lung Cancer Initiative’s research, education, awareness & access programs. The Event - Four-person, Captain’s Choice tournament - Registration includes green fee for 18 holes, range balls, cart, and lunch - Awards for top teams - Putting contest - Prizes for closest to the pin, longest drive and more! - Fantastic door prizes available - Mulligans available for purchase on event day - No rain date will be scheduled Saturday, May 2, 2015 12:00 PM Shotgun Start Schedule of Events 10:30 – Event Day Registration (Range available) 11:00 – Lunch available 11:45 – Rally/Rules of play 12:00 – Shotgun start 5:00 – Awards Ceremony Participation Opportunities Tee Sponsor - $500 - Registration for 4 players included - Sponsor’s name in text on one tee sign at event* - Sponsor’s logo included on event webpage Individual Players - $75 or $300 per foursome Pin Flag - $125 (deadline: 4/14/15) Dedicate a keepsake pin flag to promote your business, or to honor a loved one. To order, see registration form on back. Registration Form Lung Cancer Golf Classic Buies Creek Registration Fees (Must be received by Monday, April 27, 2015): Complete this form and mail it with your credit card information or enclose check(s) payable to Lung Cancer Initiative $500 Tee Sponsor (includes 4 players) $300 Foursome $75 Individual (you will be placed on a team) Please write Buies Creek Golf in the memo. Send completed registration forms and payment to: Lung Cancer Initiative of NC 4000 Blue Ridge Road, Suite 170 Raleigh, NC 27612 Registration Fee $_________ Tee Sponsor (includes 4 players) $_________ Player #1 (Captain) Name _______________________________ Pin Flag(s)* – Qty x $125 $_________ Street Address __________________________________________ City ____________________ State______ Additional Donation $_________ Zip ______________ Total $________ E-Mail _________________________________________________ Phone _________________________________________________ *Pin Gender: flag to say:__________________________________________ M/F Handicap / Average Score _________________ I am a lung cancer survivor Player #2 Name _______________________________________ E-Mail _________________________________________________ Phone _________________________________________________ Gender: M/F Handicap / Average Score _________________  I am a lung cancer survivor Player #3 Name _______________________________________ E-Mail _________________________________________________ Phone _________________________________________________ Gender: M/F Handicap / Average Score _________________ I am a lung cancer survivor Player #4 Name ________________________________________ E-Mail _________________________________________________ Phone _________________________________________________ Gender: M/F Handicap / Average Score _________________ I am a lung cancer survivor Flag(s) ($125 ea.): Please print what you wish the ___________________________________________________   I’m using a logo (email [email protected]) I am paying by: Check Cash Visa Mastercard AMEX Discover Name on Card ___________________________________________ Card Number ____________________________________________ Exp. Date _____/______ CVC Code ______________ Billing Address __________________________________________ ______________________________________________________ Players must sign the following event waiver on event day: I, the undersigned, know that the event I am entering carries the risk of personal injury or damage. I certify that I am physically fit for this event. I hereby waive and forfeit all rights I may have to file suit or make claims against Lung Cancer Initiative & the directors thereof, the City of Buies Creek, NC, any sponsoring organizations & all persons connected with this golf tournament for injuries I may suffer at this event on May 2, 2015. I understand that no refunds can be made if the event is canceled due to weather conditions or other circumstances beyond the control of the organizers. I understand that from photos taken at the event, my likeness may be used in future marketing and promotional materials for the Lung Cancer Initiative of North Carolina. Questions? Contact Khaki Stelten, Lung Cancer Initiative of North Carolina P: (919) 784-0410 or [email protected] Can’t make it to the event? Use the above form to make a credit card, cash, or check donation, or purchase a Pin Flag. You can also register online at BuiesCreek.kintera.org/2015 Visit LungCancerInitiativeNC.org for additional information.