8th Annual Golf Outing Signup Form 9/19/2026, Check in 8:30 am, Tee off 10:00 am @ Valley Ridge Golf Course - Antioch, 40150 N Illinois 59, Antioch, IL 60002 Name(Required) First Last Email(Required) Phone(Required)How many golfers are you registering? (1-4)(Required)Please enter a number from 1 to 4.Golfer 1(Required) First Last Golfer 1 Email(Required) 1st Golfer's Shirt Size(Required)SmallMediumLargeExtra Large2 XL3 XL4 XL5 XLGolfer 2(Required) First Last Golfer 2 Email(Required) 2nd Golfer's Shirt Size(Required)SmallMediumLargeExtra Large2 XL3 XL4 XL5 XLGolfer 3(Required) First Last Golfer 3 Email(Required) 3rd Golfer's Shirt Size(Required)SmallMediumLargeExtra Large2 XL3 XL4 XL5 XLGolfer 4(Required) First Last Golfer 4 Email(Required) 4th Golfer's Shirt Size(Required)SmallMediumLargeExtra Large2 XL3 XL4 XL5 XLGolfer Fees Price: $0.00 Total How would you like to make your registration payment? I will make my payment now by credit card Pay later Platinum or higher sponsor (Golfer registration only) During check-out, golfers can pay by credit card. Golfers who choose the "Pay later" option can make payment via cash or check at the event or send funds via PayPal or Venmo using the How to Help - Donate page of this site.Address Street Address Address Line 2 City AlabamaAlaskaAmerican 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 Credit Card Payment Information American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name If mailing a check, please submit the form and then mail your check to: The Butterfly Effect of Maddox J. LoPriore FoundationP.O. Box 265 Lake Villa, IL 60046 (This address will also be emailed to you after your submission).
