LCCC/Jack Nicklaus Scholarship Golf Benefit Presented by First Place Bank August 11, 2008 Elyria Country Club     Registration Form       First Name:   Last Name:   Company Name:   Address:       City:   State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY   Zip:   Telephone:   Fax:   Email:   I would like to register for: Quantity     Golf Cart Sponsor at $2,500 $ Tee & Green Sponsor at $1,500 $ Breakfast Sponsor at $2,500 $ Clinic Sponsor at $5000 $ Reception Sponsor at $3,500 $ Single Player at $600 (cost without sponorship) $ Single Player at $500 (cost with accompanying sponorship) $ Clinic/Reception ticket at $50/each $         Total   $      Note: To change a quantity back to zero, enter a "0" into the field.   After submission of this form, an invoice will be mailed to you.