15th Annual Transportation Commissioner Tom King Charity Golf Tournament
Benefiting the Diabetes Foundation of Mississippi

Monday, September 16, 2019
Canebrake Country Club 1 Cane Drive, Hattiesburg, Mississippi 39402
Registration and Lunch: 11:00 a.m. Shotgun Start: 1:00 p.m.


Secure Payment Form
If you have any questions or this form doesn't allow you to choose the options you wish, don't hesitate to call the Diabetes Foundation of Mississippi at 601-957-7878.
Teams (Individuals are considered Player 1)



Team Two for Presenting Sponsor Level




Registration Options
  • Sponsorships
  • I'd like to be a Lunch Sponsor! @ $1,000
    I'd like to sponsor the Drink Cart! @ $500
    I'll sponsor the Scoreboard @ $300

Individual Hole Sponsorships
  • ($150.00 per hole)

YES! I want to prepay for 2 Mulligans and a 5 for $5
  • ($25.00 per person)

 
Order Summary:
Order Date: 09/15/19
Total Amount: 0.00
           
Credit Card Information:
Card Type:

Name as on Card:
Card Billing Address:
Card Billing Zipcode:
Card Number:
Card Expiration Date: MMYY
Card ID (CVV2/CID) Number:
 
[What is the Card ID?]
   
Billing Information:
Company Name:
First Name:
Last Name:
Address:
Address Line 2:
City:
State:
Zip:
Country:
Phone Number:
Email Address:
     
Shipping Information:
Same as Billing:
Company Name:
First Name:
Last Name:
Address:
Address Line 2:
City:
State:
Zip:
Country:
Phone Number: