Medical Alert Application

Founders Award Tickets

"*" indicates required fields

Step 1 of 4

25%

Hidden

Date Registered

MM slash DD slash YYYY

My Name*

First Last

My email address*

Mailing Address*

Address City State Zip

Purchase Info

I Would like to:

Purchase Tickets

Only make a donation

General Tickets: $60 each Quantity

Price: $60.00

Quantity

Sponsorship Tickets: $125 each Quantity

Price: $125.00

Quantity

Optional donation to North Fork Women:

Donate to North Fork Women:

Optional reimbursement of your credit card fee:

Total

You will receive a confirmation from North Fork Women.

First and Last names of my guests*

Your name tag is your ticket. Include your name and any other people you are paying for.

Notes to North Fork Women

Payment Info

Credit Card

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

Hidden

Event Name

Hidden

Fund

Hidden

Event Date

MM slash DD slash YYYY

Name

This field is for validation purposes and should be left unchanged.

Contact me for entry support:

"*" indicates required fields

Name*

First Last

Please contact me by:*

Check all that apply

Text

Phone / Voice

Phone

Confidential note to North Fork Women:

Optional

Comments

This field is for validation purposes and should be left unchanged.

Purchase For Benefit Entry, Raffles, or Donations

"*" indicates required fields

Purchaser Name*

First Last

Email*

This is the email address where raffle tickets (if any) and confirmations will be sent.

Mailing Address*

Street Address City State ZIP Code

What would you like to purchase?

I would like to purchase the following:*

Select all that apply.

Raffle Tickets $100 each

General Entry Tickets $80 per person

Sponsor Entry Tickets $250 per person

Make a Donation to North Fork Women

Purchase Raffle Tickets Here

Raffle Price

Price:

Raffle Quantity*

How many raffles are you purchasing?

Raffle Names*

Type name(s) that are to be printed on your raffle(s)

Raffle Subtotal

Purchase General Tickets Here

General Entry Ticket Price*

Price:

General Ticket Quantity*

Number of General Entry Tickets @ $80 each

General Entry Tickets Subtotal

Names of the people for whom you are purchasing General Entry tickets*

Your Name Tag is your entry ticket to the Beneﬁt. Make sure to type the names of the people you are paying for in order for them to appear on the door list. Type names exactly as you want them to appear on their name tag. Separate multiple names with commas. All Tickets will be held at the door.

Purchase Sponsor Tickets Here

Each sponsor ticket includes entry for one plus two drink tickets.

Sponsor Ticket Price

Price:

Each sponsor ticket includes entry for one plus two drink tickets.

Sponsor Ticket Quantity*

Number of Sponsor Tickets @ $250 each

Names of the people you are purchasing Sponsor Entry tickets for*

Type names exactly as you would like them to appear on their name tag. Separate multiple names with commas.

Sponsor Tickets Subtotal

Optional Donation

Make an optional donation to North Fork Women in an amount of your choosing:

Optional Fee Payment

The Credit Card fee is $2.50 per $100. Pick the amount to reimburse to NFWFWF. Thank you!

Notes to North Fork Women:

Grand Total

Credit Card

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

Name

This field is for validation purposes and should be left unchanged.

Purchase Raffles Here

"*" indicates required fields

Purchaser Name*

First Last

Email*

This is the email address where raffle tickets and confirmations will be sent.

Mailing Address*

Street Address City State ZIP Code

Raffles

Raffle Price

Price:

Raffle Quantity*

How many raffles are you purchasing?

Raffle Names*

Type name(s) that are to be printed on your raffle(s)

Raffle Subtotal

Optional Credit Card Fee Payment

The Credit Card fee is $2.50 per $100. Pick the amount to reimburse to NFWFWF. Thank you!

Notes to North Fork Women:

Grand Total

Credit Card

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

This field is for validation purposes and should be left unchanged.

Signup Here

GOLF • DONATIONS • SPONSORSHIPS • POST-GOLF ONLY CELEBRATION

"*" indicates required fields

Step 1 of 5

20%

Before you signup please have the following info ready:
• For Golf Play: The number of people you are paying for, their first and last names, and the names of other people you want to be in your foursome.
• For Sponsorships: If you are using a logo, have your file ready to upload.

Purchaser Contact Info

Your Name*

First Last

Email*

Company Name

Address Info*

Mailing Address City State ZIP Code

I would like to purchase the following:

Check all that apply

Yes, I would like to purchase a Sponsorship

Yes, I would like to purchase tickets to the Post-Golf Celebration Only. Note: This event is included to all Golf players.

I would like to make a donation to North Fork Women

Please Note: If you are purchasing a Sponsorship check to see if your level includes complimentary golf registrations. If you would like to purchase golf registrations in addition to your sponsor level, also check the 'Yes, I would like to Play Golf on May 22, 2023' box.

Sponsor Purchase Info

Sponsorships Available

Presenting Sponsorship One available. The Presenting Sponsorship Includes: • Exclusive signage highlighting sponsorship throughout event • Highlight sponsorship level with company name/logo on North Fork Women website • Event signage (golf hole, cart, posters) • Announcement on all North Fork Women social media • Ability to place swag/information in golf gift bag • Opportunity for a company speaker for welcome at the post-golf celebration • Complimentary foursome for golf outing

Lunch Sponsorship One available. The Lunch Sponsorship includes: Exclusive signage highlighting sponsorship at lunch • Highlight sponsorship level with company name/logo on North Fork Women website • Event signage (golf hole, cart, posters) • Announcement on all North Fork Women social media• Opportunity for a company speaker for welcome at Tee-Off • Ability to place swag/information in golf gift bag • Complimentary foursome for golf outing

Platinum Sponsorships include: Highlight sponsorship level with company name/logo on North Fork Women website • Event signage (golf hole, cart, posters) • Announcement on all North Fork Women social media• Opportunity for a company speaker for welcome at Tee-Off • Ability to place swag/information in golf gift bag • Complimentary

Gold Sponsorships include: Highlight sponsorship level with company name/logo on North Fork Women website • Event signage (golf hole, cart, posters) • Announcement on all North Fork Women social media • Ability to place swag/information in golf gift bag • Complimentary twosome for golf outing

Silver Sponsorships include: Highlight sponsorship level with company name/logo on North Fork Women website • Event signage (golf hole, cart, posters) • Announcement on all North Fork Women social media • Ability to place swag/information in golf gift bag • Complimentary registration for one for golf outing

Golf Hole Sponsorships include: Highlight sponsorship level with company name/logo on North Fork Women website • Event signage (golf hole, posters) • Announcement on all North Fork Women social media • Ability to place swag/information in golf gift bag

Golf Cart Sponsorships include: Highlight sponsorship level with company name/logo on North Fork Women website • Event signage (golf cart, posters) • Announcement on all North Fork Women social media • Ability to place swag/information in golf gift bag

The Presenting Sponsor Level includes four complimentary golfers:

The Lunch Sponsor Level includes four complimentary golfers:

The Platinum Sponsor Level includes four complimentary golfers:

The Gold Sponsor Level includes two complimentary golfers:

The Silver Sponsor Level includes one complimentary golfer:

Total

Your Sponsor Level includes event signage:

Type what you would like to appear on your Tee Sign, Golf Cart Sign, and Poster.

Your Golf Hole Sponsorship includes signage:

Type what you would like to appear on your Tee Sign and Poster.

Your Golf Cart Sponsorship includes signage:

Type what you would like to appear on your Golf Cart Sign and Poster.

Upload your logo, photo or artwork if applicable:

Uploading an image is optional — or it can be emailed at a later date to golf@northforkwomen.org.

Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, ai, eps, txt, doc, docx, Max. file size: 50 MB.

Purchase for Post-Golf Celebration Only

Includes only the post-golf celebration with open bar, appetizers, and the Awards Ceremony at Stonewall’s Restaurant from 4:30 – 7:30 p.m.

How many people are you purchasing Post-Golf Celebration tickets for?*

For those who prefer to root, sip, nibble and chat instead of play golf.

Names of those that are coming to the Post-Golf Celebration*

Please type the first and last names of those who are attending the Post-Golf Celebration only.

Total

Optional Donation to North Fork Women

Every little bit helps us help others!

Optional donation to North Fork Women:

Optional reimbursement of your credit card fee:

Total

Notes to North Fork Women

Credit Card Info

Total

Credit Card

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

This field is for validation purposes and should be left unchanged.

Softball Signup Form

"*" indicates required fields

Play Softball with the Girls!

You must fill out the following form in order to play Softball on Saturday, June 10, 2023. Mattituck Park District requires each player to electronically sign the Hold Harmless Agreement below. Persons who don't comply will not be able to play.

Wavier of Liability, Release and Hold Harmless Agreement

All players/participants need to sign this Release/Hold Harmless Agreement to be eligible to participate in any sports related activities conducted on Mattituck Park District/ Mattituck School District property.

I, the undersigned,

Your Name*

First Last

affirm that I am participating in the sport activity that I have registered for below, and further represent, covenant and agree, on behalf of myself and my heirs, assigns, and any other person claiming, by under, or through me, as follows:

I acknowledge that participating in this Sports Activity involves certain risks and that injuries, death, property damage or other harm could occur to others or me. I accept and voluntarily incur all risks of any injuries, damages, or harm, which arise during or result from my participation in the Activity. These risks include, but are not limited to, the possibility of accident or illness while traveling to and from events as well as any injury arising out of participation in the physical activity involved with this Activity.

I understand and assume the risks to have direct or indirect contact with individuals which have been exposed to and/or diagnosed with one or more communicable diseases, including but not limited to COVID-1 9 or other medical conditions, diseases, or maladies, and/or mutation or variation thereof does exist and it is impossible to eliminate such risk that I could become infected through contact with or close proximity to an individual with a communicable disease. Further, I agree to follow all the rules and regulations promulgated in accordance with the applicable New York State Department of Health Guidance to be enforced by the subject organization. The Mattituck Park District and its employees shall not be liable for the contraction of COVID-l 9, or any other communicable disease, arising from the participation in this program.

I do voluntarily accept and solely assume all risks and dangers involved or incidental to the sports activity for which I have registered, whether occurring on the Mattituck Park District/Mattituck School District activity/playing area, or on any part of the Mattituck Park District/Mattituck School District owned activity/playing area. I agree that I am voluntarily participating in the activity knowing and appreciating the risks and danger associated with this activity.

I understand and assume the risks inherent in the sports activity in which I am participating including but not limited to the risks of injury from accidents, actions of other participants, topography of the activity/playing area, weather conditions, defects or injury resulting from equipment, balls, bats, nets, playing surface and defects and obstacles where the activity is being played.

I voluntarily agree to indemnify, hold harmless and release the Mattituck Park District, its trustees, commissioners, officers, employees, agents, and representatives and the Mattituck-Cutchogue Union Free School District, its trustees, officers, employees, agents and representatives, from and against claims, costs, judgments, suits, losses, damages, liens, encumbrances and expenses, including without limitation, attorneys’ fees, arising our of acts or omissions or negligence of the participant, its agents, guests, employees or contractors, in connection with the use of the permitted area referred to in the permit or activity in connection with this activity.

I have carefully read and fully understand all of the above terms and condition, and by my signature below, freely and voluntarily agree to be bound to those terms.

I understand that by typing my name and clicking on the "Submit" button, I am electronically signing this document.

Your First and Last Name*

Today's Date*

MM slash DD slash YYYY

Your Email*

Your Phone*

Notes

Comments

This field is for validation purposes and should be left unchanged.

Zoom info for Book Reading

North Fork Women is inviting you to a scheduled Zoom meeting.

Topic: ‘Get Lit’ Author’s Reading
Time: Mar 25, 2023 02:00 PM Eastern Time (US and Canada)

Join Zoom Meeting:
https://us02web.zoom.us/j/87656284989?pwd=UUFWRldsWGRaYUprMkxUN3Zseno2QT09

Meeting ID: 876 5628 4989
Passcode: 571691

One tap mobile
+19294362866,,87656284989#,,,,*571691# US

Dial by your location
+1 929 436 2866 US

Find your local number: https://us02web.zoom.us/u/kct4yzojB

Medical Alert Description + Requirements