4th Annual
Karen's Hope Ataxia Benefit
Registration Form

Complete this form to register for the 2005 Karen's Hope Ataxia Benefit. Click Submit when ready to send.
After completing this form, please mail a check payable to Minnesota Medical Foundation for your entry or sponsorship fee by June 1, 2005 to:

Karen's Hope Ataxia Benefit
c/o Kathy Guderjahn
13134 Crolly Court
Rosemount, MN 55068

You may wish to print this page for your reference before clicking Submit. Thank you for supporting Karen's Hope in 2005!

Sponsor Level and Registration
If you would like to register for the golf or dinner events only, as a non-sponsor, please skip to the next section.

Sponsor Level:

$2,000 Eagle
$1,000 Birdie
$500 Par
$250 Benefit

Sponsor/Company Name:
Address:
City/State/Zip:
Phone:
Email Address:

Participant Registration
Complete this section if you are golfing or attending the dinner. All sponsor team members should also be included in this section.

Participant #1 Name:
Address:
City/State/Zip:
Phone:
Email Address:
Participant Type:

Sponsor Team Member
$125 Golf & Dinner
$40 Dinner Only

Would you like to volunteer at the event or provide an additional donation?

I am interested in volunteering at the event
I would like to donate an item to the silent auction
I plan to support Karen's Hope with an additional financial donation in the amount of:
Participant #2 Name:
Address:
City/State/Zip:
Phone:
Email Address:
Participant Type:

Sponsor Team Member
$125 Golf & Dinner
$40 Dinner Only

Would you like to volunteer at the event or provide an additional donation?

I am interested in volunteering at the event
I would like to donate an item to the silent auction
I plan to support Karen's Hope with an additional financial donation in the amount of:

Participant #3 Name:

Address:
City/State/Zip:
Phone:
Email Address:
Participant Type:

Sponsor Team Member
$125 Golf & Dinner
$40 Dinner Only

Would you like to volunteer at the event or provide an additional donation?

I am interested in volunteering at the event
I would like to donate an item to the silent auction
I plan to support Karen's Hope with an additional financial donation in the amount of:

Participant #4 Name:

Address:
City/State/Zip:
Phone:
Email Address:
Participant Type:

Sponsor Team Member
$125 Golf & Dinner
$40 Dinner Only

Would you like to volunteer at the event or provide an additional donation?

I am interested in volunteering at the event
I would like to donate an item to the silent auction
I plan to support Karen's Hope with an additional financial donation in the amount of:
Any comments?