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2012 Centurion Golf Classic

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					                       Learning for Life                                   Special Thanks to Our 2011 Sponsors
                                                                                                                Ti


         2012 Centurion Golf Classic                                                         Title Sponsor
                 REGISTRATION FORM                                                             Centurion
                       PLEASE PRINT CLEARLY
                                                                                             Tournament Eagle
__________________________________________
Name                                                                                          Tom Nehl Truck Co.
                                                                                                   CertiSure
__________________________________________
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
SPONSORSHIP LEVEL
                                                                                           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:                     www.centuriongolfclassic.com
(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
                                                   more……………..
                                                                                                                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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