Sponsorship Registration Form

YES, we will support the Lanie Hannah Benefit Scramble by contributing:

                     *          Gold                                        $5,000 (or higher $_________)

                     *          Silver                                       $1,000

                     *          Bronze                                     $750

                     *          Goody Bag                              $750

                     *          Dinner                                      $750

                     *          Bev Cart                                  $750

                     *          Lunch                                      $500

                     *          Putting Contest                        $500

                     *          Hole Sponsor                          $350

                     *          Donation of the following auction item(s) (Include $ value)

                                  ____________________________________________

Please Print Clearly

Company Name___________________________________________________________________________

Address_________________________________________ City__________________ State_____ Zip______

Contact Name_____________________________ Phone__________________________________________

            Players

1.______________________________________________________________________________________

2.______________________________________________________________________________________

3.______________________________________________________________________________________

4.______________________________________________________________________________________

Payment Method:

                        Check enclosed (payable to Lanie Hannah Benefit Scramble)

                        Visa               MasterCard

                        Name on Card ________________________________________________

                        Credit Card No. ________________________ Exp. Date _______________

                        Signature _____________________________________________________

#             You do not need a whole team to play.

#             NO REFUNDS AFTER SEPTEMBER 1, 2004.

#             SPONSORSHIP REGISTRATION AND CANCELLATION DEADLINE - SEPTEMBER 1, 2004 AT 5:00 P.M.

#             Mail Sponsorship Registration Form and payment to: LHBS, PO Box 57, Dennis, TX 76439

For More Information Please Call: Chris Hannah @ 817-613-6658