1. 2019 ASIS Rochester New York CHAPTER #022
Raffle / Prize Donor Form
Name:_______________________
Company:____________________
Address:_____________________
City:________State:____ Zip:____
Phone:_______________________
_______________________
Item Description:
_____________________________
Item Value: $_______
Is this item a certificate? Yes No
Can you share with us any further
details or instructions about your
donation?
Please contact Lori Schreib for further
details in regards to donations:
Phone:
Donations can also be mailed to Lori at:
Wegmans Food Markets
400 Wegmans Market Street
Rochester, NY 14624
Annual Golf Outing
Mill Creek Golf Club
Monday August 5th, 2019 Shotgun 10am Mill Creek Golf Club 128 Cedars Avenue Churchville, NY

2. Registration Reply Form
Sponsorship Information
___ Corporate Sponsor $550.00
Golf Foursome
Sign at Hole
Company Logo on Banner displayed at registration desk and dinner.
____ Hole Sponsor $250.00
____ Golf Foursome $400.00
____ Individual Golfer $100.00
____ Dinner only Contribution $40.00
____ Reserve Dinner for ____ guest(s)
____ Sorry I cannot attend, however, I wish to make a donation of ______
For Additional 
Information Please Contact:
Joe Giorgione
Registration Reply Form
Format: 18 Hole Scramble Entry: $ registration fee includes: driving range, greens fees, cart, lunch, dinner & prizes. Schedule: Monday August 5th Shotgun 10am Mill Creek Golf Club 128 Cedars Avenue Churchville, NY 14428
Name:________________________________
Company:_____________________________
Address:______________________________
City:______________State:____ Zip:_______
Phone:_______________________________
________________________________
Members of foursome are ($100/player):
1. ___________________________________
2. ___________________________________
3. ___________________________________
4. ___________________________________
Make Checks Payable to :
ASIS Rochester # 022
“Golf Outing” in memo line
Mail Payments to:
Bob Lukasiewicz
225 Chestnut Street
Rochester, NY 14604