Annual Scholarship Picnic & Golf Scramble Registration Form

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Friday June 9, 2023

Golf Team Registration begins May 5th at 10AM via call to 812-838-8135.

7:00 AM CT Begin Gathering
7:30 AM CT Tee Off
1st Plate Lunch Served at 11:30AM

Location: Countrymark Refining and Logistics, LLC
6855 Lower New Harmony Rd, Mount Vernon, IN 47620

Contact Stacee Dover at (812) 838-8135 or stacee.dover@countrymark.com
Check are to be made payable to Indiana Oil and Gas Association

Mail to: PO BOX 272, Mount Vernon, IN 47620

Primary Contact Name *

Primary Contact Email *

Company Name *

Primary Contact Phone *

Number of Picnic Tickets $30 each. If playing golf, you do not need a Picnic Ticket. Please select the number of Picnic Tickets for needed for lunch ticket only. You will be contacted at a later time to provide the names of attendees.

Golf Team (each golfer receives one picnic ticket)

Submit player names below to reserve a golf team

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Golf Scramble - Player 1: Team Leader (Name and Company)

Golf Scramble - Player 2 (Name and Company)

Golf Scramble - Player 3 (Name and Company)

Golf Scramble - Player 4 (Name and Company)

Golf Scramble - Player 5 (Name and Company)

Golf Scramble - Player 6 (Name and Company)

Sponsorship

$1000 - Super

$500 - Gold

$300 - Silver

$250 - Bronze

$150 - Banner

$300 - Signage

$300 - Breakfast

$300 - Snacks

$300 - Ice Cream

$750 - Beverage

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