CDIAUSA Hole Sponsorship & Donation Form

*required

SPONSORSHIP LEVEL  *
 Platinum Sponsor - $ 1500
 Gold Sponsor - $1000
 Silver Sponsor - $750
 Bronze Sponsor - $500
I do not wish to be a sponsor but would like to donate:  Specify Amount $

CONTACT INFORMATION
Name*

Organization / Company
   Telephone

E-mail Address*

Comments / Reason for the Donation *

Donation Total: $

Credit Card Information (all fields required)
Card Type

Cardholder's First Name

Cardholder's Last Name

Credit Card Number

Exp Date
(e.g.: 05/2019)
Security Code

 

Cardholder's Billing Street Address

Billing City

Billing State
(2-digit state code)
Billing Zip Code

Billing Country
(2-digit country code)