Registration Form

Sponsorship Levels

___Gold Sponsor $600
Two golfers, w/ dinner, an acknowledgement sign in dining hall with company name and logo plus 2 tickets for Grand Prize

___Platinum Sponsor $800
Four golfers, w/dinner, an acknowledgement sign on a Tee with a company name and logo plus 4 tickets for the Grand Prize


Participation Levels

___Individual Golfer $100

___Foursome $400



Signs for Purchase

___Tees $200

___Golf cart $100

___Dining room $50


Contact Information

Name: ____________________________

Company: _________________________________________

Address: _____________________________________________

City: __________________________________

State: ______________ Zip: _______________

Phone: ________________________________ Ext: __________

Fax: _________________________________

Email: __________________________________

Dinner Selection/s: ___ (#)baked chicken or ___ (#)stuffed pork chop

Golfers' Names and Email Addresses

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Please complete this form and include your business card returned by July 11, 2009:

Make checks payable to Michael Ackman Fund

Send registration form to:
Michael Ackman Fund
Attn: Hack for Ack
124 Breezewood Drive
Venetia, PA 15367