The 19th Annual. MediSys Classic

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1 The 19th Annual MediSys Classic To Benefit Flushing Hospital Medical Center and Jamaica Hospital Medical Center Monday, May 22, 2017 Honorary Chairman Cono Grasso, M.D. Chairman Department of Ophthalmology Jamaica Hospital Medical Center Old Westbury Country Club Old Westbury, New York

2 Schedule of Activities: 9:30am Registration Brunch 11:30am Start Time Snacks & Beverages 5:00pm Cocktails/Dinner Reception 6:30pm Dessert Awards Presentation Raffle Drawing If you have any questions, please call the Development Department: (718) or (718) DIRECTIONS Old Westbury Country Club 270 Wheatley Road Old Westbury, NY Via LI Expressway (Eastbound) - To Exit 39 (Glen Cove Rd). Continue east along service road for 0.8 mile to Wheatley Road (third light). Make a left at Wheatley Road, go over Expressway and continue 1.4 miles to stop sign at T-intersection. Turn left and continue 0.5 mile to Club entrance on the left (Yellow Blinking Light). Via LI Expressway (Westbound) - To Exit 40E (Jericho), go past 2 lights, continue along service road (495 West) for 2 miles to Post Rd. (first light). Turn right on Post and continue 1.2 miles (at stop sign of Post/ Wheatley, continue straight through the intersection do not turn) to Club entrance on the left (second Yellow Blinking Light). Via Northern State Parkway - To Exit 32 North (Post Rd.). Continue on Post for 2.8 miles (at stop sign of Post/Wheatley, continue straight through the intersection do not turn) to Club entrance on the left (second Yellow Blinking Light).

3 MediSys Classic 2017 NAME COMPANY ADDRESS CITY STATE ZIP TELEPHONE FAX CELL SPONSORSHIP OPPORTUNITIES o Hole Sponsor: $2,000 Company name on hole sign o Refreshment $2,000 Company name on signage at Stand Sponsor: Refreshment Stand/grill o Platinum: $11,500 2 foursomes, dinner reception sponsor o Gold: $8,500 1 foursome, dinner reception sponsor o Silver: $6,500 1 foursome, brunch reception sponsor o Corporate: $4,500 1 foursome o Health/Wellness $2,500 includes 2 dinner reservations o Tennis $2,500 includes 2 dinner reservations Logo/Co. name on signage at court o Competition $3,000 includes 2 dinner reservations Sponsor* * Supports the Golf and Tennis 1st, 2nd, & 3rd prizes. TAX DEDUCTIBLE INFORMATION Contributions are tax-deductible to the extent allowed by law. Level of Participation Value of Goods Tax Deductible & Cost / and Services Amount Platinum / $11,500 $3,080 $8,420 Gold / $8,500 $1,540 $6,960 Silver / $6,500 $1,540 $4,960 Corporate / $4,500 $1,540 $2,960 Competition / $3,000 $360 $2,640 Golf Balls / $5,000 $360 $4,640 Umbrella / $4,000 $360 $3,640 Travel Mug / $3,500 $360 $3,140 Golf Towel / $3,000 $360 $2,640 Shoe Bag / $3,000 $360 $2,640 Golf Cart / $4,500 $360 $4,140 Driving Range / $2,500 $360 $2,140 Tennis / $2,500 $360 $2,140 Health/Wellness / $2,500 $360 $2,140 Refreshment Stand / $2,000 $0 $2,000 Hole / $2,000 $0 $2,000 UNDERWRITER OPPORTUNITIES (one sponsorship available for each)* All to include your company logo on item, PLUS two tickets to dinner reception o Golfer Apparel $6,500 o Golf Ball $5,000 o Golf Cart $4,500 o Golf Umbrella $4,000 o Golf Towel $3,000 o Golf Travel Mug $3,500 o Shoe Bag $3,000 o Driving Range $2,500 *Deadline April 24th PLEASE RESERVE THE FOLLOWING: o $500 ea o Tennis $350 ea o $350 ea Includes: yoga, pilates, massage, etc... o Dinner $250 ea 19 th ANNIVERSARY Golfer Only / $500 $385 $115 Tennis Only / $350 $250 $100 Health/Wellness Only / $350 $250 $100 Dinner Only / $250 $180 $70

4 Please list the names of players in your foursome Company/name as you would like it to appear on HOLE SIGN CONTRIBUTION (see form) o I/We cannot attend, but enclosed is a tax-deductible contribution in the amount of $ o I/We cannot attend, but would like to donate a raffle prize in excess of $200 o I/We cannot attend, but would like to be included in the Booster Listing o I/We cannot attend, but would like to donate a day of golf for the silent auction PAYMENT INFORMATION Please send payment with this registration form. Payment is expected prior to event Please make your check payable to: MediSys Health Network and mail to: GOLF CLASSIC DEVELOPMENT DEPARTMENT MEDISYS HEALTH NETWORK 8900 VAN WYCK EXPRESSWAY, JAMAICA, NY For more information, please call (718) or (718) Reservations may be faxed to (718) Or send to: or

5 2017 MediSys Classic Raffle Prize Donation Form (Tax ID # ) NAME TITLE COMPANY ADDRESS CITY STATE ZIP TELEPHONE ITEM TO BE DONATED VALUE HOW/WHEN ITEM WILL BE SENT Goody Bag Donation Form (Tax ID # ) NAME TITLE COMPANY ADDRESS CITY STATE ZIP TELEPHONE ITEM TO BE DONATED VALUE HOW/WHEN ITEM WILL BE SENT PLEASE MAIL OR FAX THIS FORM TO: MediSys Classic Development Department MediSys Health Network 8900 Van Wyck Expressway, Jamaica, NY OR FAX: (718) Contributions are tax-deductible to the extent allowed by law.

6 Booster Listing What is a Booster Listing? We are offering our dedicated supporters who don t play golf, tennis or attend the dinner, the opportunity to be included in our Thank You Book of Recognition. It is our way of thanking our donors who support us each and every year through sponsorships, raffle prize donations, goody bag items, etc. By being a participant in this listing, you can still support both Flushing Hospital Medical Center and Jamaica Hospital Medical Center. As a booster, your level of support will be listed in our Thank You Book by category. Every gift, regardless of the amount, is important and valued. Booster levels are as follows: q Tournament... $750 - $1,250 (listing only) q Hole in One... $500 - $749 (listing only) q Eagle... $250 - $499 (listing only) q Birdie... $100 - $249 (listing only) q Par... $50 - $99 (listing only) I would like my name/company/department to be listed as follows: Name (Print clearly) Address Please see enclosed registration card for payment, mailing and fax information. Booster Listing Deadline: Friday, May 12th

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