For more information contact:

Helen Limbert Geisinger–Shamokin Area

Community Hospital Administration4200 Hospital Road

MC 62-03Coal Township, PA 17866hclimbert@geisinger.edu

Phone: 570.644.4229 Fax: 570.644.4351

geisinger.org

The official registration and financial information of Geisinger Health System Foundation may be obtained from the Pennsylvania Department of State by calling toll free, within Pennsylvania, 800.732.0999. Registration does not imply endorsement. Additional information is available by calling Geisinger Health System Foundation at 1.800.739.6882. Geisinger Health System Foundation, 100 North Academy Ave., Danville, PA 17822-2576.

If you do not wish to participate in future fundraising activities of Geisinger Health System Foundation, please call 1.800.739.6882.

Sponsor Levels$2,500 Gold Sponsor • Foursome •Choice of Tee-Off Location (awarded in order

of receipt of sponsorship)•Premier recognition along the Sponsor “Walk

of Fame”•Company logo placed on the 2014 Golf

Tournament reservation webpage as a featured sponsor

•Recognition at on-course refreshment stations

$1,500 Silver Sponsor • Foursome •Choice of Tee-Off Location (awarded in order

of receipt of sponsorship)•Premier recognition along the Sponsor “Walk

of Fame”•Recognition at on-course refreshment stations

$1,250 Lunch Sponsor—Limited to one•Premier recognition at the luncheon

$1,000 Bronze Sponsor • Foursome •Recognition along the Sponsor “Walk of

Fame”

$650 Team Hole Sponsor • Foursome • Tournament signage

$500 On-Course Refreshments Sponsor—Limited to two•Premier recognition at on-course refreshment

stations

$300 Individual Hole Sponsor • 1 player in the tournament• Tournament signage

$150 Friends Sponsor• Tournament signage

$100 Individual Player

23rd Annual

Friday, September 5, 2014

Indian Hills Golf Club Paxinos, PA

Rain Date: Friday, September 12, 2014

Join us for a day of golf and excitement

78852-1-7/14-ALW/BF

Memorial Golf Tournament

Jane F. KorbichAs we celebrate the 23rd anniversary of our golf tournament, we take a moment to remember our colleague and friend, Jane F. Korbich, for whom the tournament was renamed after she lost her courageousfightwithlungcancerin1999.Herentiremedical career was spent working diligently at the hospital where she provided steadfast leadership, and emphasized compassionate care.

Tournament DetailsWe strive to provide you a very enjoyable golf day with many extras throughout the tournament. Special golf contests include closest to the pin, longest drives, and most accurate drives. Each golfer will also receive a special gift.

We hope you can join us on September 5!

• Playerswillbeplacedona“firstcome,firstserved”basis.Deadlineforregistrationis Friday, August 22, 2014. Please return completed entry form and payment by the deadline to ensure that your registration will be processed without any delay.

•Sponsorship includes green and cart fees, lunch, snacks, beverages, heavy hors d’oeuvres and much more.

•Scramble format.•Rain date – September 12, 2014• For more information or to pay and register

online, visit geisinger.org/100.

Tournament Schedule•Registration starts at 11:30 am• Lunch at 11:30 am to 12:45 pm•Shotgun start 1 pm

Contests•Closest to the Pin (women and men)• Longest Drive (women and men)•Most Accurate Drive (women and men)

In Support ofAs in the past, all proceeds will continue to support Geisinger–Shamokin Area Community Hospitalpriorityinitiatives.

Sponsorship LevelsGold Sponsor .............................................$2,500

Silver Sponsor ............................................$1,500

Lunch Sponsor ...........................................$1,250

Bronze Sponsor ..........................................$1,000

TeamHoleSponsor–Foursome ...................$650

On-Course Refreshment Sponsor .................$500

IndividualHoleSponsor–SinglePlayer........$300

Friends Sponsor ............................................$150

Individual Player ............................................$100

RegistrationPlease fill out this form in its entirety and return it to the name and address on the reverse side.

Contact: ______________________________________

Company: ____________________________________(please indicate sponsor name as you would like it to appear)

Address: ______________________________________

Phone: _______________________________________

E-mail: _______________________________________

PlayersPlease fill out this form in its entirety.

Player 1: ______________________________________

Player 2: ______________________________________

Player 3: ______________________________________

Player 4: ______________________________________

Sponsorship level: _____________________________

Total amount enclosed: _________________________

Lunch number attending: _______________________

Awards Reception number attending: ____________

Method of Payment•PleasemakecheckspayabletoGHSFoundation•Pleasechargemy: Visa Mastercard Discover

American Express

Account # ____________________________________

Expiration date ________________________________

In the amount of $ _____________________________

______________________________________________Signature as it appears on your card

Reservations including sponsorships can be made online at geisinger.org/100.