Geisinger Lewistown Clay Shoot

The official registration and financial information of Geisinger Health System
foundation may be obtained from the Pennsylvania Department of State by
calling toll free, within Pennsylvania, 800-732-0999. Registration does not imply
endorsement. Additional information is available by calling Geisinger Health
System Foundation at 800-739-6882. Geisinger Health System Foundation,
100 N. Academy Ave., Danville, PA 17822-2576. If you do not wish to participate
in future fundraising activities of Geisinger Health System Foundation,
call 800-739-6882.
Geisinger Lewistown
Clay Shoot
Sat., Aug. 20, 2016
For more information, contact
Lauren Hassinger at 717-242-7226
or lnhassinger@geisinger.edu.
Mifflin County Sportsmen’s Association
Lewistown, PA
To benefit the Friends of Geisinger Lewistown Hospital
and Geisinger Lewistown Hospital
Individual shooters:_____x $50 each = $___________
Number of additional
lunch tickets:__________x $10 each = $____________
Total:______________________________________
Visa
Discover
MasterCard
American Express
Card #:_____________________________________
Expiration date:______________________________
Amount to be charged:________________________
Signature:__________________________________
Checks should be made payable to Geisinger Health
System Foundation and mailed to:
Geisinger Health System
Geisinger Lewistown Clay Shoot
c/o Bethany Heitzman
geisinger.org
100 N. Academy Ave.
Danville, PA 17822
MC 25-76
84202-1-6/16-LH/DS
Geisinger Lewistown Clay Shoot
Sponsorship opportunities
Registration
Sat., Aug. 20, 2016
Information must be received no later than Aug. 1
to ensure placement in the program book.
Organization:_________________________________
Mifflin County Sportsmen’s Association
(Event will take place rain or shine.)
Competition for individual shooters will begin at 9 a.m.
Shooters will be grouped into squads of five and will
shoot two rounds, one clay and one trap. 50 birds total.
No handicaps. Bring your own gun, ammunition, safety
glasses and earplugs. Limited ammunition for sale at the
event. Gun safety knowledge is required. Shooters of all
levels/abilities welcome. Awards will be given on behalf
of Cabela’s and other local sponsors.
Registration........................................................................ 8 a.m.
Beginner shooters’ clinic....................................... 9 – 11 a.m.
Clay shoot rounds begin .............................................. 9 a.m.
Lunch provided...................................................................Noon
Continued clay shoot rounds........................................ 1 p.m.
Event wrap-up celebration............................................ 6 p.m.
at Cora’s Creekside Tavern in Burnham, PA
• Look for special targets during the competition for
door prizes.
• Awards will be given via Lewis Class.
Proceeds
The proceeds from this year’s clay shoot will be
distributed to the Friends of Geisinger Lewistown
Hospital with a large portion benefitting Geisinger’s
Medication Take-Back Program.
Geisinger’s Medication Take-Back Program provides a
convenient means for patients to dispose of all unused
or expired medications, ensuring increased safety for
our residents and our water supply, and preventing the
illegal diversion of prescription drugs. MedReturn lock
boxes will be placed in Caresite pharmacies close to
where patients live, learn, work and play. Secure pickup and incineration is managed by the Pennsylvania
National Guard.
$2,000 level
• Includes squad of 5 paid participants
• 50 additional birds per shooter
• Recognition in the event program
• Signage at the event
• Promotion on clay shoot event page on Geisinger
Foundation page
• Booth availability the day of the event
$1,500 level
• Includes squad of 5 participants
• 50 additional birds per shooter
• Recognition in the event program
• Signage at the event
• Promotion on clay shoot event page on Geisinger
Foundation page
$1,000 level
• Includes squad of 5 participants
• 25 additional birds per shooter
• Recognition in the event program
• Signage at the event
$500 level
• Includes squad of 5 paid participants
• Recognition in the event program
• Signage at the event
$300 level
• Sponsor a local 4-H team (squad of 5 students) to
participate on behalf of your business
• Recognition in the event program
• Signage at the event
$250: Sportsman sponsor
• Recognition in the event program
• Signage at the event
Contact name:________________________________
Address:___________________________________
City/state/zip:________________________________
Phone/email:________________________________
Registration due by Aug. 12, 2016.
Register online at geisinger.org/foundation.
Sponsorship level: $_________________________
Name to appear in program: ___________________
Team captain:
_________________________________________
Squad member name:
_________________________________________
Age:_________ Veteran:_______________________
Squad member name:
_________________________________________
Age:_________ Veteran:_______________________
Squad member name:
_________________________________________
Age:_________ Veteran:_______________________
Squad member name:
_________________________________________
Age:_________ Veteran:_______________________
Squad member name:
_________________________________________
Age:_________ Veteran:_______________________
(over for payment information)