Choose a Sponsorship Level:
*
Tee: >$100
Par: $100 - $399
Birdie: $400-$499
Eagle: $500 - $749
Albatross: $750 - $999
Condor: $1,000+
Are you Registering a Team of 4?
Yes
No
Team Members:
If registering a team, please list first and last names of each team member
Sponsorship Amount
*
prev
next
( X )
USD
Please Enter Sponsorship Donation Amount
Debit or Credit Card
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Name
*
First Name
Last Name
Company Name
Email
*
Email is collected to send a confirmation of purchase
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Logo to be used for website & signs
Browse Files
Drag and drop files here
Choose a file
Alternately you can email the logo to info@waterburyambulance.org
Cancel
of
Sponsor
Should be Empty: