Citizens State Bank Hall of Fame Golf Classic Name* First Last Phone*Email Address* Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Team InformationTeam Name* Are You Participating on the Team?*YesNoTeam Captain Name To ensure we can reach a player from each team to provide updates on day of event, please provide the name and contact information for a player on your team. Team Captain Phone Team Captain Email Player Information – To add an additional player, click on the plus (+) button after each line.NameEmailPhone Number Please provide information about each player on your team. If not all players are known, please fill in the players who are known and provide additional names to Development Director, Trip Lukemeyer at firstname.lastname@example.org. prior to event. Ambassador PreferenceEach Fivesome will be paired with a Hall of Fame Ambassador to play the round. Please fill out the information below so that we can learn more about your team and find a great ambassador for you! Do you have a preferred ambassador?*YesNoWhat is your preferred ambassador's name? Please provide your preferred ambassador's contact information Do you have a preferred College(s) your ambassador is connected to? Do you have a preferred High School(s) your ambassador is connected to? Payment InformationPurchase options Fivesome $750 Individual $150 Hole Sponsor $100 Fivesome and Hole Sponsor $850 Fivesome Price: Individual Price: Hole Sponsor Price: Combo Price: Total $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name CAPTCHAHole Sponsor InformationPlease upload the logo or graphic to use for the Hole Sponsor SignMax. file size: 300 MB.Please provide any wording you would like to see on the Hole Sponsor SignCommentsThis field is for validation purposes and should be left unchanged.