2017 Seafood Scramble Registration

Seafood Scramble Registration Form

When: October 17th

Registration Deadline: October 13th

Please mail registration payment to:

Jala Hayes
315 W. Hickory Street
Sylacauga, AL 35150

Make checks payable to Coosa Valley Medical Center Foundation or call 256-401-4070 to pay with a credit card.

Level of Sponsorship*
- EAGLE Sponsor - $1200.00 - Includes four players, four tournament gifts, acknowledgement of sponsorship on a course hole.
- BIRDIE Sponsor - $800.00 - Includes two players, two tournament gifts, acknowledgement of sponsorship on a course hole.
- PAR Sponsor - $400.00 - Includes one player, one tournament gift.
- PRESENTING Sponsor - $3,500
- Tournament Gift Sponsorship - $3,000
- Breakfast Sponsorship - $500
- Lunch Sponsorship - $1,500
- Evening Snack Sponsorship - $500
- Mobile Hole/Beverage Cart Sponsorship - $500
- Hospitality Tent - $350
- Mulligan Tent Sponsor - $300
*Each Player fee includes: cart, tournament gift & Seafood Scramble buffet available from 11:30am-1:30pm.
Tee Time Requested*
- 8:30 a.m.
- 1:30 p.m.
Company/Sponsor Name*
Player 1 Information
Player #1- H’cap*
Player 1 Name*
Player 1 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Player 1 Phone Number*
Player 1 Email*
Player 2 Information
Player #2- H’cap
Player 2 Name
Player 2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Player 2 Phone Number
Player 2 Email
Player 3 Information
Player #3- H’cap
Player 3 Name
Player 3 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Player 3 Phone Number
Player 3 Email
Player 4 Information
Player #4- H'cap
Player 4 Name
Player 4 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Player 4 Phone Number
Player 4 Email
For more information please contact Jala Hayes at 256-401-4070 or email at jala.hayes@cvhealth.net

2017 Seafood Scramble Registration

Seafood Scramble Registration Form

Player 1 Information

Player 2 Information

Player 3 Information

Player 4 Information