Accident Fund - Agent Services: Westran Insurance Scholarship Foundation

Team Captain:		Roy Westran Memorial Insurance Industry Scholarship Outing Join us to benefit the Westran Insurance Scholarship Foundation. Friday, August 7, 2009 at Hawk Hollow Golf Course.
Company:
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Team Member:
Company:
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Phone/Fax:
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Team Member:
Company:
Email:
Phone/Fax:
Address:
City/State/Zip:

Team Member:
Company:
Email:
Phone/Fax:
Address:
City/State/Zip:

Please select below
Yes No	Individual Golf Only $175
Yes No	Foursome Only $700
Yes No	Mentor $800
Yes No	Instructor $1,100
Yes No	Educator $2,500
Other Non-Golf Sponsorships Available
Yes No	Driving Range $500
Yes No	Practice Putting Area $500
Yes No	Lunch Sponsor $1,000
Yes No	Beverage Sponsor $1,000
Yes No	Reception Sponsor $2,000
Total:
Payment:	I will mail my check payable to: Westran Insurance Scholarship Foundation Mail to: Scott Burgess Westran Insurance Scholarship Foundation P.O. Box 40790 Lansing, MI 48901-7990 I will make payment with cash or a check on August 7 2009 at the event.