2012 Centurion Golf Classic

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					                       Learning for Life                                   Special Thanks to Our 2011 Sponsors

         2012 Centurion Golf Classic                                                         Title Sponsor
                 REGISTRATION FORM                                                             Centurion
                       PLEASE PRINT CLEARLY
                                                                                             Tournament Eagle
Name                                                                                          Tom Nehl Truck Co.
Address                                                                                         Platinum Eagle
                                                                                SE Toyota Distributors/ JM Family Enterprises
__________________________________________                                                      The LBA Group
Name of Business
                                                                                                  Gold Eagle
Signature                                                                                          Tire 1
                                                                                             Eaton Corporation
Phone Number                                                                          Mr. & Mrs. Tom Nehl and Family
                                                                                            Rush Truck Center
                                                                                           Dixon Auto Transport                              Learning for Life Presents
                                                                                               Eve Partners
□ Tournament Eagle Level                           $7,500 and above
                                                                                                 Silver Eagle                             2012 Centurion Golf Classic
□ Platinum Eagle Level                             $5,000
                                                                                                                                               “A Tradition of Caring”
□ Gold Eagle Level                                 $2,500
                                                                         International Auto Processing
                                                                         Taylor & Martin, Inc.
                                                                                                                   Cottrell Trailers
                                                                                                                   Dixon Auto Transport
□ Silver Eagle Level                               $1,000                Jack Becker Distributors, Inc.            Arvin Meritor

□ Individual Golfer                                $150
                                                                         Travelers Insurance
                                                                         Batten Capital
                                                                                                                   Fleet One
                                                                                                                   Suntrust Bank             TO BENEFIT SCOUTING FOR
□ Donation only $___________                                             Rush Truck Center-Jacksonville            Pilot Fuel/Flying J
                                                                                                                                              SPECIAL NEEDS CHILDREN
                                                                         Aramark Uniform Services                  Michelin
                                                                         Simons Petroleum                          James A. Nolan, PA
Please include appropriate amount and mail to:
                                                                         Dixon Hughes Goodman                      Cintas
            Learning for Life                                            Montoya Benefits Group                    Kenworth
                                                                         Fowler White Boggs                        Verizon
            2011 Centurion Golf Classic
                                                                         Smith Hulsey & Busey                      Nextran Truck Center
            521 South Edgewood Ave.                                      Life and Health Insurance                 Erwin Insurance
            Jacksonville, FL 32205                                       Kim Stanley Insurance & Financial Services

                                                                                       website designed & donated by :
Questions? Call 904-388-0591, or fax us at 904-387-4148.
                                                                                 CC & A Graphic Design- Alean Roddenberry
Please pay by check or credit card (AMEX not accepted):                  We would like to thank you, our sponsors and especially The

□ Visa                                □ Mastercard                       Shafer Family of Centurion Auto Transport for your contin-
                                                                         ued support. Centurion Auto Transport of Jacksonville, FL
___________________________________________                              has supported the Special Needs Scouting for over 23 years.
Card #                                             Expiration Date
                                                                         Because of your participation, the program will be able to

_______________________________                    _____________
                                                                         touch the lives of even more of these exceptional children;        Monday, September 24, 2012
                                                                         making a positive impact on many future generations.
Signature                                          3 Digit Code
                                                                                       2011 & 2012 printing donated by:           
(Make all checks payable to Learning for Life, North Florida Council.)
                                                                     Event Schedule                                 2012 Centurion Golf Classic
     Sponsorship Levels
                                                          Monday, September 24, 2012
   Tournament Eagle $7,500 and up                                                                               Complete information below and return with check

    3 golf tournament foursomes
                                                           Deercreek Country Club                               Golfer ___________________________ Handicap___
    Hole sponsorship & signage throughout event              7816 McLaurin Road North                           Address ____________________________________
    Golf lunch for 12                                          Jacksonville, FL 32256
                                                                                                                City _________________State______ Zip __________
    Banner recognition at Special Needs Camporee                            Golf
                                                                                                                Email__________________________ Shirt Size______
    Program recognition                            7:30 a.m. - Registration and Silent Auction opens
                                                                                                                Company Phone______________________
    Complimentary foursome at Deercreek
    Country Club                                   8:30 a.m. - Shotgun start

          Platinum Eagle $5,000                    1:30 p.m. - Lunch, Awards and Silent Auction
                                                                                                                □ Pair me with other players
    2 golf tournament foursomes                    Silent Auction: Bid on Airline tickets, Wild Ad-
                                                   ventures, Kennedy Space Center, Casa Monica
    Hole sponsorship & signage throughout event
                                                   brunch, golf foursomes at beautiful courses around
                                                   Jacksonville, wine tasting party, and so much                Golfer ___________________________ Handicap___
    Golf lunch for 8
                                                                                                                Address ____________________________________
    Program recognition
    Complimentary foursome at Deercreek
                                                                  Hotel Available                               City _________________State______ Zip __________
    Country Club
                                                                     Hampton Inn                                Email __________________________ Shirt Size______
             Gold Eagle $2,500
                                                                 8127 Point Meadows Drive                       Company Phone______________________
    Golf tournament foursome                                       Jacksonville, FL 32256
    Hole sponsorship & signage throughout event                         904-363-7150
                                                                                                                □ Pair me with other players
    Golf lunch for 4                                       discount rate of $89.99/night plus tax
                                                                                                                Golfer ___________________________ Handicap___
    Program recognition                                     To get the discounted rate, mention
                                                                the Centurion Golf Classic                      Address ____________________________________
    Complimentary foursome at Deercreek
    Country Club
                                                         Special Needs Scouting in the                          City _________________State______ Zip __________
            Silver Eagle $1,000                             North Florida Council
                                                                                                                Email __________________________ Shirt Size______
    Golf tournament twosome
                                                                                                                Company Phone______________________
    Hole sponsorship
    Golf lunch for 2                                                                                            □ Pair me with other players
    Program recognition                                                                                         ____________________________________________
                                                                                                                Golfer ___________________________ Handicap___

Deercreek Country Club is a picturesque golf       Special Needs Scouting is a Learning for Life program        Address ____________________________________
community located on the Southside of Jack-        designed for children who are mentally, emotionally, or
                                                   physically impaired, multi-disabled, visually, or hearing    City _________________State______ Zip __________
sonville, FL near the beaches. Designed by
                                                   impaired. We are able to provide these children an oppor-
Robert Miller , the private 18-hole golf course                                                                 Email __________________________ Shirt Size______
                                                   tunity to help them grow in all areas. The program focuses
brings out the competitive golfer, with its
                                                   on Character and Life Skills Development, Behavior Man-      Company Phone______________________
challenging carries, demanding doglegs, and        agement, Mental and Physical Fitness, Citizenship Train-
sentinel pines lining the fairways.                ing, Motivation, and Self-esteem.                            □ Pair me with other players

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