If you have problems registering please e-mail or call 860-346-1924 and we'll be happy to process your registration over the phone.

Registrant / Sponsor Information

All sponsorship levels include company logo on Andrew's Golf Benefit For Epilepsy webpage. Sponsors must register by July 1, 2019 to receive all benefits. Send company logo to info@epilepsyct.com by July 1, 2019. Click Here For Sponsorship Details »

If you are a company looking to sponsor and can not pay by credit card, please e-mail or call 860-346-1924 to initiate your registration.

* First name:
* Last name:
Company:
* Phone:
* E-mail:
* Address:
* City, State, Zipcode:
* Sponsorship Level:
Other Donation: $

Who's Golfing?

Individual Golfer Registration- $160 per golfer. Includes 18 holes of golf with cart, golfer gift, sleeve of balls, breakfast, lunch, and BBQ banquet after play

Player 1 Name:
Player 1 Email:
Player 1 Address:
Player 1 City, State, Zipcode:

Player 2 Name:
Player 2 Email:
Player 2 Address:
Player 2 City, State, Zipcode:

Player 3 Name:
Player 3 Email:
Player 3 Address:
Player 3 City, State, Zipcode:

Player 4 Name:
Player 4 Email:
Player 4 Address:
Player 4 City, State, Zipcode:

Comments:
* Please Enter the word EPILEPSY


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