7th Annual Golf Outing Registration Form | The Butterfly Effect of Maddox J. LoPriore Foundation

Golfer Registration Form

9/20/2025, Check in 8:30 am, Tee off 10:00 am @ Spring Valley Country Club 23923 Wilmot Rd Salem WI

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.

How many golfers will upgrade to VIP?(Required)

Golfer 1(Required)

First Last

Golfer 1 Email(Required)

1st Golfer's Shirt Size(Required)

Golfer 1 is VIP?(Required)

Golfer 2(Required)

First Last

Golfer 2 Email(Required)

2nd Golfer's Shirt Size(Required)

Golfer 2 is VIP?(Required)

Golfer 3(Required)

First Last

Golfer 3 Email(Required)

3rd Golfer's Shirt Size(Required)

Golfer 3 is VIP?(Required)

Golfer 4(Required)

First Last

Golfer 4 Email(Required)

4th Golfer's Shirt Size(Required)

Golfer 4 is VIP?(Required)

Golfer 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 State ZIP Code

Credit Card Payment Information

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

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 Foundation
P.O. Box 265
Lake Villa, IL 60046

(This address will also be emailed to you after your submission).