Questions? Get in Touch: (409) 212-6113 Sponsorship Level Details Sign Up Online: Registrant InformationCompany/Organization Name As you want to appear on signageContact Name* First Last Mailing Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Please Reserve A Team For UsChoose Level Baptist Big Shot (Title Sponsor) - $5,000 3,000 Sponsor - $3,000 1,500 Sponsor - $1,500 Beverage Sponsor - $500 Shell Bag Sponsor - $1,000 Door Prize Sponsor - $1,000 Station Sponsor (Single Station) - $300 Station Sponsor (Two Stations) - $500 Team Only (Includes Golf Cart) - $750 Individual Entry (Includes Golf Cart) - $200 Payment MethodPlease choose payment method:* By Check Credit Card I cannot attend but wish to donate Please make check payable to Baptist Hospitals of Southeast Texas and send to the following address: Baptist Hospitals of Southeast Texas Foundation 3070 College Street, Suite 401 Beaumont, TX 77701How much would you like to donate? Finalize PaymentIs your card's billing address the same as the address listed above? Yes No Billing Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Total $0.00 This page is unsecured. Do not enter a real credit card number! Use this field only for testing purposes. Credit CardCard Details Cardholder Name
