Dixon Public School District Foundation

OFFICIAL ENTRY FORM
Team Name: ____________________________________________ Email: _______________________
Contact person: __________________________________________ Phone: ______________________
Mail Address: ________________________________________________________________________

How many teams are you sponsoring?

 Non-Profit Teams @ $150/team ................................................................ =

$_______

 Corporate/Business Teams @ $300/team ................................................... =

$_______

 $100 Foundation Donation ....................................................................... =

$_______

Total Fees Submitted ................................................................................. = $_______

ROSTER
Relationship to Organization
Team Member Names

(3 must be an employee/member, a spouse, or retiree)

1.

_____________________________ (Captain)

_________________________________

1.

___________________________________

_________________________________

2.

___________________________________

_________________________________

1.

___________________________________

_________________________________

1.

___________________________________

_________________________________

1.

___________________________________

_________________________________

1.

___________________________________

_________________________________

2.

___________________________________

_________________________________

3.

___________________________________

_________________________________

4.

___________________________________

_________________________________

Make Checks Payable to: Dixon Public School District Foundation or "DPSD Foundation"
Submit this form with your check by Jan. 24, 2014, to:
Attn: Roxie Mahan (Fax 284-8576 or E-mail rmahan@dixonschools.org)
1335 Franklin Grove Road Dixon, IL 61021

This official entry form, when submitted, is a binding contract between the Dixon Public School District Foundation and your organization.

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