ORGANIZATION CONTACT FORM

Organization:
Taxpayer ID:

MAIN CONTACT
First Name:		Last Name:
Title:		Email:
Phone:		Cell:
Fax:
Address:		City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip:
*** NOTE *** This contact will receive all TICKETS Fore CHARITY emails, correspondence, and check distribution.

SECONDARY CONTACT
First Name:		Last Name:
Title:		Email:
Phone:		Cell:
Fax:
Address:		City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip:
*** NOTE *** This contact will receive all TICKETS Fore CHARITY emails and correspondence, but will not receive the monthly check distributions.

A Nationwide Tour Players Cup representative will contact you when this information is received. Should you have any questions in the meantime, please feel free to contact
Chase McClain at (304) 848-2027 ext. 157.

If you prefer a printable version of the COUNT ME IN! form click here (please fax this printable version to (304) 842-4323 or e-mail to cmcclain@mcneelysports.com).