Mount Kisco Country ClubSeptember 12, 2022 27th Annual Golf Outing Monday September 12, 2022 10:00 AM Registration & Breakfast – 11:00 AM Shotgun Start Please enable JavaScript in your browser to complete this form.Personal InformationName *FirstLastDaytime Phone *Email *EmailConfirm EmailBilling Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeOuting InformationNumber Attending Golf Outing, Reception & Dinner01234$325.00 Per Person (If you have more than one foursome. Please register each foursome separately.)(FYI Minimum tips for caddies $40/person)List Other Golfers in Group:Golfer 1 (Full Name) *Golfer 1 (Email)Golfer 2 (Full Name) *Golfer 2 (Email)Golfer 3 (Full Name) *Golfer 3 (Email)Golfer 4 (Full Name) *Golfer 4 (Email)Number Attending Cocktail Hour Only012345678910$100.00 Per PersonPLATINUM EVENT SPONSOR:Yes $5,000Includes two paid foursomes, plaque awarded to sponsor & sign on display at sign-inGOLD LUNCHEON SPONSOR:Yes $2500Includes paid foursome, plaque awarded to sponsor & sign on display at lunchSILVER DRIVING RANGE SPONSOR:Yes $1250.00Includes paid twosome, plaque awarded to sponsor & sign on display at range:COMPANY, INDIVIDUAL OR FAMILY TEE SPONSORYes $200.00Sign on display at TeeSponsorship to Read *Unfortunately, I cannot attend but please accept my contribution of:Additional ContributionGrand Total$ 0.00Select Payment Option *Paypal (Credit Card)Pay By CheckPlease make check payable to “The Jack DeVito Foundation” and mail with this form to: The Jack DeVito Foundation334 Underhill Ave., Suite 4D Yorktown Hgts., NY 10598If you have any questions, please contact us at 914.273.3626 or email [email protected] The Jack DeVito Foundation is a not-for-profit (501-C3) corporation Thank you for supporting the youth in our communities***Additional opportunities to contribute through raffles, contests & auctions - (FYI Minimum tips for caddies $40/person) *** WebsiteSubmit