Birdies for Charity Donation Form

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1 Birdies for Charity Donation Form By donating, you are automatically entered into the Guess the Birdies contest. Mail entries to: Shriners Hospitals for Children c/o Birdies for Charity 2900 N. Rocky Point Drive, Tampa, FL * Please make checks payable to: Shriners Hospitals for Children and include "Birdies for Charity" in the memo line. Personal Information: Full Name: Please provide a valid address. All winners (grand prize and others) will be notified via . Company: Phone Number:

2 Your Donation: Donation amounts are based on the number of birdies guessed, not the actual number of birdies recorded. For example, if you donate $0.01 per birdie and you guess 2,000 birdies will be made during the tournament, the donation will total $ If 2,500 birdies are made, the donation total remains $20.00 and the Guess the Birdies entry is 2,000. The tournament covers all administrative costs for the program and turns over 100% of all monies collected to Shriners Hospitals for Children. Choose your donation option below: Donate per Birdie: # of Birdies: Amount per Birdie: Total: Fixed Amount: # of Birdies: Donation Amount: Direct my gift to: Billing Information: Name on Card: Billing Address: City: State/Province: Zip/Postal Code: Country: Payment Information: Credit Card Type: Visa Discover American Express Master Card Credit Card Number: CVV Number: Expiration Date: I've read and agreed to the Guess the Birdies contest rules

3 SHRINERS HOSPITALS FOR CHILDREN OPEN GUESS THE BIRDIES SWEEPSTAKES OFFICIAL RULES NO DONATION, PURCHASE OR PAYMENT OF ANY KIND NECESSARY TO ENTER OR WIN SWEEPSTAKES. A DONATION OR PURCHASE DOES NOT INCREASE YOUR CHANCES OF WINNING A PRIZE IN THIS SWEEPSTAKES. SPONSOR: Shriners Hospitals for Children, 2900 Rocky Point Drive, Tampa, FL. TIMING: The Shriners Hospital For Children Open Guess the Birdies Sweepstakes ( Sweepstakes ) begins at 12:00:00 AM Eastern Daylight Savings Time ( EDT ) on May 30, 2017 and ends at 11:59:59 PM EDT on November 1, 2017 (hereinafter, Sweepstakes Period ). ELIGIBILITY: ENTRANTS MUST BE LEGAL RESIDENTS OF THE FIFTY (50) UNITED STATES, THE DISTRICT OF COLUMBIA, CANADA OR MEXICO WHO ARE THE AGE OF MAJORITY WITHIN THE JURISDICTION FROM WHICH THEY RESIDE ON THE DATE OF ENTRY. VOID OUTSIDE THE UNITED STATES, THE DISTRICT OF COLUMBIA, CANADA AND MEXICO AND WHERE PROHIBITED BY LAW. You may enter this Sweepstakes only as a natural person. Sweepstakes is subject to all applicable federal, provincial, state, and local laws and regulations. TWO WAYS TO ENTER: A) DONATION ENTRY: During the Sweepstakes Period, go to and complete the Guess The Birdies Donation Form by submitting your complete name, a valid address, telephone number, the donation amount per Golf Birdie and the number of Birdies that will take place during the 2017 Shriners Hospitals for Children Open between November 2 and 5, 2017, your total donation amount, and the name on your valid credit card, credit card account number, expiration date, CVC, billing address information and the Shriners Hospitals for Children location that you would like your donation to support; OR B) FREE ENTRY: During the Sweepstakes Period, go to click the FREE ENTRY link and complete the Guess The Birdies Sweepstakes Entry Form by submitting your complete name, a valid address, telephone number and the total number of Birdies that will take place during the 2017 Shriners Hospitals For Children Open between November 2 and 5, (A and B, are individually defined as Entry and collectively defined as Entries ). ALL ENTRIES MUST BE RECEIVED BY 11:59:59 PM EDT ON NOVEMBER 1, No photocopies or mechanically reproduced Entries permitted. Limit one (1) Entry per person, per household, regardless of Entry method. Multiple Entries or duplicate Entries will be disqualified. Your Entry constitutes your consent to participate in this Sweepstakes and your consent for Sponsor to obtain and deliver your name, address and other information to Centra Marketing and Communications, LLC ( Administrator ) for the purpose of administering this Sweepstakes. Use of robotic, automatic, or macro devices is not valid for Entry. Any Entry that is submitted with the use of a robotic, automated or macro device will be void. All Entries become the property of the Sponsor upon submission and will not be acknowledged or returned and the Sponsor has the right to dispose of the Entries at Sponsor s discretion. By submitting an Entry, entrant agrees to abide by the terms of these Official Rules, that information submitted is subject to the Sponsor s Privacy Policy available at DETERMINATION OF WINNERS: The entrant who submitted the actual number of Birdies that took place among all completed rounds during the 2017 Shriners Hospitals for Children Open between November 2 and 5, 2017 will be deemed the Grand Prize Winner; the two (2) entrants who submitted the next closest number of Birdies closest to the actual number of Birdies that took place among all completed rounds during the 2017 Shriners Hospitals for Children Open between November 2 and 5, 2017 will each be deemed a First Prize Winner; and the next three (3) entrants who submitted the next closest number of Birdies closest to the actual number of Birdies that took place among all completed rounds during the 2017 Shriners Hospitals for Children Open between November 2 and 5, 2017 will each be deemed a Second Prize Winner. In the event of a tie whereby more than one (1) Entrant submitted the actual number of Birdies that took place among all completed rounds during the 2017 Shriners Hospitals for Children Open, all tied entrants will be entered into a Random Drawing and one (1) Grand Prize Winner, up to two (2) First Prize Winners and up to three (3) Second Prize Winners will be selected among all tied Entrants. In the event there are no entrants that submitted the actual number of Birdies that took place among all completed rounds during the 2017 Shriners Hospitals for Children Open, the Grand Prize will be awarded

4 to the Entrant who submitted the number of Birdies closest to the actual number of Birdies that took place and First and Second Prize Winners will be selected in a Random Drawing from among all remaining eligible entries received. In the event of a tie among those who submitted the number of Birdies closest to the actual number of Birdies that took place among all completed rounds during the 2017 Shriners Hospitals for Children Open between November 2 and 5, 2017, all tied entrants will be entered into a Random Drawing and one (1) Grand Prize Winner, up to two (2) First Prize Winners and up to three (3) Second Prize Winners will be selected among all tied Entrants. A Random Drawing will then be conducted from among all remaining entries received throughout the program to select the balance of first and second prize winners. In the event a Random Drawing to select winners at any prize level is required, the Random Drawing will be conducted by the Administrator on or about November 7, Odds of winning in the Random Drawing depend on the number of tied Entries. Sweepstakes entrants agree to be bound by the decisions of the Sponsor and the Administrator, which are final and binding in all matters pertaining to this Sweepstakes. Potential Prize Winners will be notified by and/or telephone on or about November 10, In the event a winner is a legal resident of Canada, before being declared a potential Prize Winner, that Eligible Entrant will be required to correctly answer, without assistance of any kind, whether mechanical or otherwise, a four-function time limited mathematical skill testing question. Failure to answer question correctly will cause prize to be forfeited. Potential Grand Prize Winner will be required to complete, sign and return an Affidavit of Eligibility/Release of Liability and Publicity ( Affidavit/Release ) unless prohibited by law, and a Form W-9 within five (5) business days of notification. Potential First Prize Winners and potential Second Prize Winners will be required to complete, sign and return a Prize Verification Form and Publicity Release, unless prohibited by law, within five (5) business days of notification. A potential Prize Winner may be disqualified under any the following circumstances; i) if he/she cannot be reached by Sponsor within the specified time period; ii) if a Prize notification or correspondence is returned as undeliverable or phone call is not answered; iii) if a potential Prize Winner is found to be ineligible; iv) if a potential Prize Winner does not return the required Affidavit/Release or Prize Verification Form Release within required time period; v) if a potential winner is unwilling to accept the prize; and/or vi) if a potential prize winner does not comply with these Official Rules. If the Grand Prize Winner is a legal U.S. resident, the Grand Prize Winner will be required to supply Sponsor with his/her social security number for tax purposes and will be issued a Form 1099-MISC as required by law. Sponsor is not responsible for fraudulent calls or s made to entrants not by Sponsor, or for any change of entrant s , telephone or mailing address. PRIZES AND THEIR APPROXIMATE RETAIL VALUES ( ARV ): ONE (1) GRAND PRIZE: One (1) Winner will receive one (1) trip for Winner and one (1) Guest to attend the 2018 Shriners Hospitals for Children Open in Las Vegas, Nevada consisting of: (i) round-trip, economy class air transportation from the major commercial airport nearest Grand Prize Winner s residence to Las Vegas, Nevada; (ii) hotel accommodations for three (3) nights (one (1) standard double occupancy room, room and tax only) at a hotel designated by Sponsor; (iii) VIP Experience at the 2018 Shriners Hospitals for Children Open for two (2) days; (iv) one (1) Meet and Greet Session with the 2018 Shriners Hospitals for Children Open Tournament Champion; and (v) two (2) tickets to a Las Vegas Show designated by Sponsor (i, ii, iii, iv and v, collectively, Grand Prize Trip ). ARV of Grand Prize: up to $2,000USD/$2,718XCAD/37,549MXM. The ARV of the Grand Prize Trip may vary depending upon the point of departure and/or airline fare fluctuations; TWO (2) SECOND PRIZES: Two (2) Winners will each receive one (1) 2017 Shriners Hospitals for Children OpenPin Flag autographed by the Tournament Champion. ARV of each First Prize: $150.00USD/204CAD/2816MXN; and THREE (3) SECOND PRIZES: Three (3) Winners will each receive 2017 Shriners Hospitals for Children Open Tournament apparel designated by Sponsor. ARV of each Second Prize: $100USD/136CAD/1877MXN. TOTAL ARV OF ALL PRIZES: UP TO $2,600USD/3,533CAD/48,816MXN. Grand Prize Winner is solely responsible for any and all expenses and incidental travel costs not expressly stated in the Grand Prize Trip description herein, including but not limited to, all ground transportation while in Las Vegas, Nevada, in-room hotel charges (e.g., mini-bar, room service, telephone, movies, etc.), meals, beverages, gratuities, gasoline, parking, tolls, souvenirs, insurance, travel upgrades, baggage fees, and personal incidentals. Grand Prize Winner will be required to provide a valid credit card at the time of hotel check-in and will be solely responsible for any and all charges to Grand Prize Winner s hotel room during his/her Grand Prize Trip. All Grand Prize Trip details not specified in the Official Rules will be determined in Sponsor s sole and absolute discretion. Selection of airline, and departure airport are solely within Sponsor s sole discretion. Grand Prize Winner and Guest will be required to travel on dates designated by Sponsor. In the event the Grand Prize Winner cannot travel on dates designated by Sponsor, Grand Prize Winner will be disqualified. In the event, for whatever reason, the 2018 Shriners Hospitals for Children Open is postponed or cancelled prior to or during the Grand Prize

5 Winner s Trip, the VIP Experience and the Meet and Greet Session with the Tournament Champion will not be awarded and no compensation will be provided in lieu of the cancelled portion of the Grand Prize Trip. Grand Prize Winner is responsible for any air travel taxes and/or expenses, including applicable departure taxes or fees, and security charges. Once issued, airline tickets are nontransferable and may not be reissued once travel has commenced. Open tickets may not be issued and stopovers are not permitted. In the event the Grand Prize Winner resides within one hundred (100) miles from Las Vegas, Nevada, Sponsor will provide round-trip ground transportation between Grand Prize Winner s residence and Las Vegas, Nevada at the sole discretion of the Sponsor and the difference in value between the round-trip air transportation and the round-trip ground transportation will not be provided to the Grand Prize Winner. Travel arrangements must be made through Sponsor and travel dates and arrangements are subject to air travel, holiday, blackout dates, availability and other prize and travel restrictions. All Grand Prize elements must be redeemed at the same time. Grand Prize Winner and his/her Guest must travel on the same itinerary. In the event the Guest is considered a minor, the Guest must travel with a parent or legal guardian on the trip. Guest s parent or legal guardian will be solely responsible for any costs incurred as a result of a parent or legal guardian traveling with the Guest, if required. Travel is subject to terms and conditions set forth in these Official Rules and those set forth by selected travel providers, availability may vary, and material restrictions may apply. Grand Prize Winner and Guest will be solely responsible for obtaining a valid U.S. Government issued identification or a valid Mexico Passport or a valid Canada Passport prior to travel and any associated costs for these requirements. Sponsor and Travel Providers shall not be responsible for any cancellations, delays, diversions or substitution or any act or omissions whatsoever by the air carriers, hotels or other transportation companies or any other persons providing any of these services and accommodations to passengers, such as changes in services or accommodations necessitated by same. Sponsor and Travel Providers shall not be liable for any loss or damage to baggage or other items. If the Grand Prize Winner is unable to or cannot otherwise fully enjoy the prize due to any reason, Sponsor shall have the option at its sole discretion of being relieved of liability for fulfillment of that Grand Prize award, and no other compensation in lieu of that Grand Prize will be awarded. Grand Prize Winner and guests are responsible for obtaining their own medical and life insurance and the associated costs. All travel is subject to any and all restrictions instituted by the Department of Defense and/or Department of Homeland Security, as required. Any difference between a stated Prize ARV and actual ARV of a Prize will not be awarded. Each prize winner acknowledges that Released Parties (as defined below) have not made nor are in any manner responsible or liable for any warranty, representation, or guarantee, express or implied, in fact or in law, relative to any prize, including but not limited to its quality, mechanical condition or fitness for a particular purpose. Any and all warranties and/or guarantees on a prize (if any) are subject to the respective manufacturers terms therefore, and winners agree to look solely to such manufacturers for any such warranty and/or guarantee. No substitution, assignment, redemption for cash, or transfer of any prize permitted. If an advertised prize cannot be awarded due to circumstances beyond Sponsor s reasonable control, a substitute prize of equal or greater value may be awarded in Sponsor s sole discretion. Prizes are subject to the Sweepstakes and all applicable federal, provincial, state and local laws. Prizes are not transferable. Applicable income and sales taxes, if any, on prizes are the sole responsibility of the Prize Winners. GENERAL CONDITIONS: The values of the prizes set forth above represents Sponsor s good faith determination of the approximate retail values thereof, and the actual fair market values, as ultimately determined by Sponsor, are final and binding and cannot be challenged or appealed. In the event a stated approximate retail value of a prize is more than the actual fair market value of that prize, the difference will not be awarded in cash or otherwise. The Sponsor reserves the right, in its sole discretion, at any time and at any stage of the Sweepstakes, to reject or disqualify any Entry that is deemed ineligible or for any reason that the Sponsor feels is necessary and/or appropriate, including without limitation, if that entrant has not complied with the Official Rules or has interfered, in Sponsor s sole opinion, with the proper conduct of the Sweepstakes. All decisions of the Sponsor are final and binding in all aspects of the Sweepstakes. By participating, each prize winner grants Sponsor permission a perpetual right to use his/her name, image, likeness or comments for publicity purposes in connection with this Sweepstakes (including, without limitation, any post-sweepstakes publicity) without additional notice or consent, and without payment of additional consideration, except where prohibited by law. WAIVER OF LIABILITY AND RELEASE: By participating in this Sweepstakes, each Entrant and each Prize Winner agrees to release and hold harmless Sponsor, the Related Entities and all other companies

6 associated with the Sweepstakes, and all of their respective officers, directors, employees, agents and representatives (collectively with Related Entities, the Released Entities ), from and against any loss, harm, damages, costs or expenses, claim or cause of action arising out of participation in the Sweepstakes or receipt or use of any prize hereunder, including, but not limited to: (a) unauthorized human intervention in the Sweepstakes; (b) technical errors related to computers, servers, providers, or telephone or network lines; (c) printing errors; (d) lost, late, misdirected, or undeliverable ; (e) errors in the administration of the Sweepstakes or the processing of entries; or (f) personal injury or death to a person(s) or damage to or loss of property which may result, directly or indirectly, in whole or in part, from Entrant s participation in the Sweepstakes or a Prize Winner s receipt, acceptance, use &/or enjoyment or misuse of the prize (including any travel or activity related thereto.) By applying for the Sweepstakes, each Entrant agrees that: (i) any and all disputes, claims, and causes of action arising out of or connected with the Sweepstakes, shall be resolved individually, without resort to any form of class action; (ii) any and all claims, judgments and awards shall be limited to actual out-of-pocket costs incurred, including costs associated with applying for the Sweepstakes, but in no event will attorneys fees be awarded or recoverable; and (iii) under no circumstances will any Entrant be permitted to obtain any award for, and each Entrant hereby knowingly and expressly waives all rights to seek, punitive, incidental or consequential damages and/or any other damages, other than actual out-of-pocket expenses, and/or any and all rights to have damages multiplied or otherwise increased. Sponsor and the Released Entities are not responsible for any typographical or other error in the printing of this Sweepstakes, the administration of the Sweepstakes or in the announcement of the Grand Prize winner, including such error as may give an erroneous indication that a prize has been won. By participating in the Sweepstakes and submitting an Entry, each Entrant agrees to defend, indemnify and hold harmless the Sponsor and Released Entities from and against any and all claims, demands, liability, damages or causes of action (however named or described) losses, costs or expenses, with respect to or arising out of or related to Entrant s participation in the Sweepstakes. Each Entrant assumes all liability for any injury or damage caused, or claimed to be caused, by participation in this Sweepstakes. In the event the integrity and/or feasibility of the Sweepstakes is undermined by any event including but not limited to fire, flood, epidemic, earthquake, explosion, labor dispute, or strike, act of God or public enemy, satellite or equipment failure, riot or civil disturbance, war (declared or undeclared), terrorist threat or activity, or any federal, state, provincial or local government law, order of regulation, order of any court or jurisdiction, or other cause not reasonably within the Sponsor s control (each a Force Majeure event) and subject to the approval of the RACJ in Quebec, the Sponsor shall have the right, in its sole discretion, to abbreviate, modify, suspend, cancel or terminate the Sweepstakes without notice or further obligation. If the Sponsor, in its discretion, elects to abbreviate, cancel or terminate the Sweepstakes as a result of a Force Majeure event, the Sponsor, subject to the approval of the RACJ in Quebec, reserves the right, but shall have no obligation, to distribute the Prizes from among all non-suspect, eligible Entrants received up to the time of such Force Majeure event. Subject to the approval of the RACJ in Quebec, Sponsor may prohibit individuals from participating in Sweepstakes and disqualify entries if they (1) attempt to enter the Sweepstakes through any means other than as described in these Official Rules, (2) attempt to disrupt the Sweepstakes or circumvent the terms and conditions of these Official Rules in any way or (3) repeatedly show a disregard for the Sweepstakes Official Rules or act (a) in an unsportsmanlike manner, or (b) with an intent to annoy, abuse, threaten or harass any other Entrant or Sponsor. Sponsor s decisions with respect to the Sweepstakes are final. Sponsor is not responsible for incompatibility of Entrant s hardware, software or browser technology with Sponsor s hardware, software or browser technology. Any litigation respecting the conduct or organization of a publicity contest may be submitted to the Régie des alcools, des courses et des jeux for a ruling. Any litigation respecting the awarding of a prize may be submitted to the Régie only for the purpose of helping the parties reach a settlement. USE OF INFORMATION: The information that you provide in connection with the Sweepstakes may be used by Sponsor in accordance with its Terms and Conditions of Use, which is found at and which may be updated from time to time without notice. WINNERS LIST/OFFICIAL RULES: To obtain a Winners List, (available after November 30, 2017), or a copy of the Official Rules, send a self-addressed, stamped #10 envelope before December 29, 2017 to: Shriners Hospitals for Children s Open Sweepstakes c/o Centra360, 1400 Old Country Road, Suite 417,

7 Westbury, NY Residents of Vermont, Canada and Mexico may omit return postage. Please specify Winners List or Official Rules on the outer envelope. ADMINISTRATOR: Centra360, 1400 Old Country Road, Suite 417, Westbury, NY Copyright 2017, Shriners Hospitals for Children Open, Tampa, Florida. All Rights Reserved.

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