The Samuel Staten, Sr. Charitable Trust – 2018 Golf Outing
Online Registration

The deadline for the Ad Book is May 1, 2018.
After May 1st, please call Dana Brady at 267-757-0720.

NOTE: We use cookies during the registration and payment process. Please make sure that cookies are enabled in your browser.

 Contact Information:
First Name:
Last Name:
Zip Code:
Day Phone:

 Sponsorships and Other Participation:
Golf Sponsorship (Please select all that apply)
Sponsor Choices:
Corporate Sponsor (8 golfers)
Includes: Your Logo on Event Signage and Your Banner at
Registration and Banquet, Flagstick (with frame to be
presented at banquet), Tee Signs at all 4 Par 3 Holes on
Course, Full Page Ad in Corporate Sponsor Section,
8 golfers and Mentions in all Event Publicity
Friends of the Council (2 golfers)
Includes: Your Logo on Event Signage, Tee Signs at
all 4 Par 3 Holes on Course, Full Page Ad in
Friends of the Council Section, 4 golfers.
Flag Stick Sponsor
(Limited Quantity Available)
Half Page Ad in Flag Stick Section and Framed Flag
Awarded to Sponsor After Tournament
Qa’id Staten Memorial Scholarship Fund Ad Book
Full Page Ad (4.5" wide x 7.5" tall, Black & White) $500
Half Page Ad (4.5" wide x 3.75" tall, Black & White) $250
Sponsorships Total: $

Other Participation:
Please enter quantities only, the prices will be computed for you
Item Quantity Total
Tee Sign Only: $1,000
Includes Tee Sign on One Hole
and Listing in the Ad Book
Single Golfer: $250 $
Dinner Only: $150 per person $
Sorry I cannot attend, but would like to make a contribution to the Qa’id Staten Memorial Scholarship Fund: $
Other Participation Total: $
Please calculate again if you made changes »  
Grand Total: $

Please enter golfer names or company name
Corporate Sponsor = 8 Golfers
Friends Sponsor = 4 Golfers
Flagstick = Company Name
Notes/Comments (optional)

 Attach Your Ad

You can send your artwork for the Qa'id Staten Memorial Scolarship Ad Book by uploading it via this form, or you can e-mail your artwork to us at

Click the "browse" button below to locate the file you wish to upload on your computer. Only Microsoft Word (.doc and .docx) and .pdf files less than 10 megabytes may be uploaded. The file will be uploaded once you submit the form. The name of the Microsoft Word or Adobe PDF file that contains your artwork should not include any spaces (e.g, mycompany_artwork.docx).

Prior to pressing Submit Registration, enter the word(s) or numbers as displayed below. Doing so helps prevent automated programs from abusing this form. If you are not sure what the word(s) or numbers are, you may enter your best guess or click the reload button (two arrows) below the image.

The Samuel Staten, Sr. Charitable Trust has raised TWO MILLION DOLLARS
for local charities in the 17 years since its inception in 1999.