Anaphylaxis

Registration Form

I would like to purchase a foursome

Gold Event Sponsor – $35,000
Foursome Sponsor - $25,000

My Foursome Includes:

Name:

Company:

Telephone:

E-Mail:

Name:

Company:

Telephone:

E-Mail:

Name:

Company:

Telephone:

E-Mail:

Name:

Company:

Telephone:

E-Mail:

PARTNER LEVEL:

Presenting Sponsor
Gold Event Sponsor
Foursome Sponsor

Dinner Sponsor
Tee Gift Sponsor

Luncheon Sponsor
Champagne Reception Sponsor
Golf Shirt Sponsor

Golf Ball Sponsor
Hole Contest Sponsor
Gift Bag Sponsor
“Win a Car” Sponsor

Name:

Address:

City:

Province:

Postal:

E-mail:

I would like to participate as a sponsor - please call me
to arrange. Phone #

I cannot attend, but would like to participate by making
the following monetary or gift-in-kind donation:

Forms:
Donation Form (PDF)
Wine Auction Donation Form (PDF)
Wine Description Form (PDF)

Cheques can be made payable to Anaphylaxis Canada, which will issue
donation receipts (charitable registration number 887208676RR0001).

Please send cheques to Heller Productions, 42 Industrial Street,
Suite 102, Toronto, ON M4G 1Y9.