Name(Required)

First Last

Facility/Business Name(Required)

Work Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

PGA Member Number(Required)

Job Title(Required)

Cell Phone(Required)

Email(Required)

Allergies/Dietary Concerns

Secure a Foursome

Secure your place in the limited field of 18 foursomes through a $4,000 entry fee for a PGA Professional and three Amateur partners. The event will include a lunch prior to an afternoon shotgun start and a post event reception. Caddies are required (most being Evans scholars) and fees will be additional. A portion of the event registration is tax-deductible and donations are 100% tax-deductible. Registrations/donations will receive tax forms directly from the Evans Scholars

Do you wish to register a foursome?

Yes, I want to secure a foursome

No, I do not wish to secure a foursome

Player #1: PGA of America Golf Professional Information

Please provide the following details for the PGA of America Golf Professional playing in this foursome.

Name

First Last

Player #1: USGA Handicap Index

Is the PGA of America Golf Professional's contact information the same as entered above?

Yes

No

Player #1: Facility/Business Name(Required)

Player #1 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country

Player #1: PGA Member Number(Required)

Player #1: Job Title(Required)

Player #1: Cell Phone(Required)

Player #1: Email(Required)

Player #2 (Amateur Partner)

Player #2: Name

First Last

Player #2: USGA Handicap Index(Required)

Player #3 (Amateur Partner)

Player #3: Name

First Last

Player #3: USGA Handicap Index(Required)

Player #4 (Amateur Partner)

Player #4: Name

First Last

Player #4: USGA Handicap Index(Required)

Are you interested in accommodations based on a first come, first served basis?

Yes

No

If yes, what is your expected date of arrival?

If yes, what is your expected date of departure?

Make a Donation: Round of Golf for Four (4) Players at Your Club

Make a donation of a round of golf for four (4) players at your club to be auctioned during the post golf event reception and through other PGA Magazine events. A minimum bid of $2,000 for each auction item will be applied, with all funds from the auction going to support the scholarship. A portion of the event registration is tax-deductible and donations are 100% tax-deductible. Registrations/donations will receive tax forms directly from the Evans Scholars

Would you like to donate a foursome at your club?

Yes

No

Make a Cash Donation

Would you like to make a donation gift to support the Evans Scholarship in memory of Larry Dornisch?

A portion of the event registration is tax-deductible and donations are 100% tax-deductible. Registrations/donations will receive tax forms directly from the Evans Scholars

Diamond level - $5,000

Platinum level - $2,500

Gold level - $1,000

Silver level - $500

Bronze level - $250

Not at this time

Total

Payment Method

A portion of the event registration is tax-deductible and donations are 100% tax-deductible. Registrations/donations will receive tax forms directly from the Evans Scholars Foundation.

Credit Card

Check

Please mail your check payment, payable to "Evans Scholar Foundation" with "Larry Dornish Pro-Am" on the memo line, and mail to: Evans Scholar Foundation C/O Larry Dornish Pro-Am 2501 Patriot Blvd. Glenview, IL 60026

Credit Card