registration Form

q Individual Golfer q Foursome q Sponsor* q Dinner Only

Foursome Names: ____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________ q (I/we) are unable to attend, but enclose our tax-deductible gift of: $ __________________________________________

q Enclosed is: $ _____________________________________

q Credit Card Type: ________________ Exp. Date__________

Name On Card _______________________________________

Card # ______________________________________________

make checks payable to Circle of Life Children’s Center and mail check and registration form to:

Circle of Life Children’s Center, Inc.274 South Orange Avenue, Newark, New Jersey 07103

Name ___________________________________________

Company Name ___________________________________

Address __________________________________________

________________________________________________

Telephone ________________________________________

Email ____________________________________________

registration deadline is august 1, 2010

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events sCheduLe

11:00 am – 12:30 pm Registration/Lunch

12:30 pm Shotgun Start

5:30 pm Cocktails, Dinner, Awards, Prizes, Auction and 50/50 Raffle

6:30 pmDinner

*Please mark desired sponsorship level on reverse side.

Circle of Life Children’s Center, Inc. (COLCC) is a 501(c)(3) nonprofit corporation, currently in its fifth year of providing programs and services to infants, children and adolescents who are seriously ill and their families through our Pediatric Palliative Care Team comprised of a Medical Director, Neonatologist, APRN, RN, and Bereavement Coordinator. The mission of COLCC is to provide a comprehensive program of palliative and end of life care for infants and children with chronic and life-limiting illnesses and their families.

Currently, pediatric palliative care and the support provided by Circle of Life to families is not a service reimbursed by state or private insurance programs. Programs dedicated to children in this sensitive area of

care are limited in their resources and rely on good will and philanthropy to keep their programs running. The care provided by Circle of Life to children living with heartbreaking illness is not readily available to most children, and their families are caught in the maelstrom of the current medical system. These simple measures reduce pain and suffering while addressing overall needs including bereavement support for surviving family members.

Proceeds from this event support Circle of Life, including in-patient, home-care programs, end-of-life family support and bereavement services, and their ultimate goal of a freestanding, homelike facility for children and families where sensitive, compassionate end-of-life and respite care can be provided in a warm, friendly, supportive environment.

CIRCLE OF LIFE CHILDREN’S CENTER, INC.Compassionate Care and Family Support for Seriously Ill Children

Board oF trustees

robert J. trobeManaging Director,

Frank Crystal & Company (NYC)marc C. Wuensch, CPa

Liebgold, Wuensch & Assoc. James m. oleske, md, mPh

Medical Director, FXB Center for Children – UMDNJ

Jeffrey h. Bunin, Bche, mBaBunin Management Advisors, LLC

scott d. shapiro, CPaWeber, Shapiro & Co., LLP

richard h. Bernstein, md, FaCPChief Medical Director,

VNS CHOICEgina m. dunsmuir, esq.

Assistant General Counsel, ComplianceC. R. Bard, Inc.

onajovwe Fofah, md. FaaPAssistant Professor of Pediatrics

Division of Neonatology, UMDNJWilliam J. KrollChairman & CEO Matheson Tri-Gas

Joel markelPresident & CEO

Preferred Healthmate, Inc.margaret J. mcLean, CFreFundraising Consulting and

Research Information Servicesrichard d. Purcell, Jr.

PresidentDNA Healthlink, Inc.

michael F. schaff, esq.Chair, Corporate & Health Care Departments

Wilentz, Goldman & Spitzer, P.A.

goLF Committee

Jeff duncanDuncan Financial Services, LLC

Joseph a. Boyle, esq.Kelley, Drye & Warren

gina m. dunsmuir, esq.C. R. Bard, Inc.

Paul FoleyLee Nolan Associates

margaret J. mcLean, CFreFundraising Consulting

John nieradkaMatrix Healthcare Servicesscott d. Pollack, aams

Pollack Financial Group, LLCdavid umbria

Lee Nolan AssociatesKenneth Zuckerberg

Carlan Associates, LLC

sPonsorshiP LeveLs

q Platinum sponsor – $15,000 Includes 2 foursomes, 2 exclusive green signs, name/logo on gift bag, banner listing, program back cover and lunch, cocktails, dinner for each member of foursome q gold sponsor – $12,000 Includes 2 foursomes, 1 exclusive green sign, name/logo on gift bag, banner listing, program inside front cover, lunch, cocktails, dinner for each member of foursome q silver sponsor – $10,000 Includes 1 foursome, 1 exclusive green sign, name/logo on gift bag, banner listing, program, inside back cover, and lunch, cocktails, dinner for each member of foursome

q Bronze sponsor – $7,500 Includes 1 foursome, poster recognition, full page ad in program and lunch, cocktails, dinner for each member of foursome

q dinner sponsor – $5,000 Includes individual poster and group sponsor poster, 2 guests for cocktails and dinner, full page ad in program

q Cocktail sponsor – $3,000 Includes individual poster and group sponsor poster, 2 guests for cocktails and dinner; half page ad in program

q Lunch sponsor – $2,000 Includes individual poster and group sponsor poster, half page ad in program

q golf Cart sponsor - $1,500 Includes half page ad in program

q awards sponsor – $1,000 Includes half page ad in program

q Photography sponsor – $1000 Includes half page ad in program

q gift Bag sponsor – $1000 Includes: half page ad in program

q Program sponsor – $750 q exclusive green sponsor – $500 q hole sponsor – $250

q individual golfer – $300 Includes golf, lunch, cocktails, dinner

q Cocktails and dinner only – $100 per person

Norma Godin Millison, Executive DirectorCircle Of Life Children’s Center, Inc.

274 South Orange Avenue I Newark, New Jersey 07103Tel: 973-273-0872 I Fax: 973-273-0873

www.circleoflifenj.org

First Annual

goLF outingMonday, September 20, 2010

Basking Ridge Country ClubBasking Ridge, NJ

11:00 am Registration 12:30 pm Shotgun Start