2019 ASIS Rochester New York CHAPTER #022 Raffle / Prize Donor Form Name:_______________________ Company:____________________ Address:_____________________ City:________State:____ Zip:____ Phone:_______________________ Email:_______________________ Item Description: _____________________________ Item Value: $_______ Is this item a certificate? Yes No Can you share with us any further details or instructions about your donation? Please contact Lori Schreib for further details in regards to donations: Phone: 585-269-8392 Email: lori.schreib@wegmans.com Donations can also be mailed to Lori at: Wegmans Food Markets 400 Wegmans Market Street Rochester, NY 14624 Annual Golf Outing Mill Creek Golf Club Monday August 5th, 2019 Shotgun Start @ 10am Mill Creek Golf Club 128 Cedars Avenue Churchville, NY 14428 http://www.asisrochester.org/

Registration Reply Form Sponsorship Information ___ Corporate Sponsor $550.00 Golf Foursome Sign at Hole Company Logo on Banner displayed at registration desk and dinner. ____ Hole Sponsor $250.00 ____ Golf Foursome $400.00 ____ Individual Golfer $100.00 ____ Dinner only Contribution $40.00 ____ Reserve Dinner for ____ guest(s) ____ Sorry I cannot attend, however, I wish to make a donation of ______ For Additional  Information Please Contact: Joe Giorgione joe@therocdome.com Registration Reply Form Format: 18 Hole Scramble Entry: $100.00 registration fee includes: driving range, greens fees, cart, lunch, dinner & prizes. Schedule: Monday August 5th Shotgun Start @ 10am Mill Creek Golf Club 128 Cedars Avenue Churchville, NY 14428 Name:________________________________ Company:_____________________________ Address:______________________________ City:______________State:____ Zip:_______ Phone:_______________________________ Email:________________________________ Members of foursome are ($100/player): 1. ___________________________________ 2. ___________________________________ 3. ___________________________________ 4. ___________________________________ Make Checks Payable to : ASIS Rochester # 022 “Golf Outing” in memo line Mail Payments to: Bob Lukasiewicz 225 Chestnut Street Rochester, NY 14604