Sponsored by:

5151 Wisconsin Ave. NW, Suite 420Washington, DC 20016

202-298-9211 / Fax 202-244-4999astancik@diabeteswellness.net

For the benefit of Diabetes Research & Wellness Foundation Programs

and F. Keane Eagen Scholarship Fund www.diabeteswellness.net

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◆ Files must be high-resolution, fonts and links included.

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Payment method:

❑ Check ❑ Mastercard ❑ Visa ❑ American Express

Card Number:

Security Code

Expiration date: _________________

Signature:

___________________________________________(required for credit card donations)

Donations are tax-deductible to the extent permitted by law.

Make your check payable to:

Diabetes Research & Wellness Foundation®

5151 Wisconsin Ave, NW, Suite 420 Washington, DC 20016

202-298-9211/Fax 202-244-4999www.diabeteswellness.net

Payment Information

Please list the names of players in your foursome:

1. _________________________________________

2.__________________________________________

3. _________________________________________

4. _____________________________________________

shoe size

MondayMay 17, 2010(Rain or Shine) at

International Country Club

F. Keane Eagen was founder and president of K & R Industries, Inc., an advertising specialty and promotional products company originally located in Fairfax, Va. Mr. Eagen, who was known by friends as Keane, ran the business for 15 years until 1993. Keane was a very proud graduate of the University of Scranton and of the education and tradition the small Jesuit University offered him after serving in the Army in Korea during the Korean War. Keane was active in his community parish at St. Ambrose Catholic Church and served on several charitable committees including lead consultant to the Annual DRWF Diabetes Classic Golf Tournament until his death in 2003.

F. Keane eagen

International Country Club13200 Lee Jackson Highway • Fairfax, Virginia 22033

(703) 968-7990 • www.internationalcc.comDirections from I-495 : • Take I-66 West 17.3 miles • Take the US-50 West exit towards

Fair Oaks/Winchester, exit #57B • Continue on US-50 for 3.7 milesInternational Country Club is located on the right hand side of the road.

9th annualF. Keane EagenDIaBeteSgOlF ClaSSIC

Call Valerie or Schuyler at 202-298-9211 or fax form to: 202-244-4999 or

email astancik@diabeteswellness.net

Schedule of EventsRegistration - 11:00 a.m.(Pro-Shop Entrance)

Pick up Gift BagsDriving Range OpenLunch – 11:30 a.m.

Shotgun Start – 1:00 p.m.Cocktails – 5:30 p.m.Dinner – 6:00 p.m.

Tournament Details

◆ 18-Hole Scramble – 4 on a team

◆ Course limited to 120 golfers

◆ Field will be broken into two flights.

Winning teams will be picked by a modified Callaway System

within each flight.

◆ First recorded Hole-In-One contest

◆ Closest to Line contest

◆ Closest to Pin contest

◆ Must use at least one (1) drive for each team player

◆ Roving Beverage Carts

◆ Driving Range open to participants

◆ Team pairing will be posted Monday morning with Hole starting position

◆ Door Prizes

◆ Locker Room facilities available to participants

Name____________________________________________

Organization ______________________________________

Address___________________________________________

City______________________________________________

State______________________Zip____________________

email____________________________________________

Phone____________________________________________

Over please, for payment information

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Please indicate your level of support

Gold Sponsor $5,000 Includes (1) golf foursome, hole sign, banner with your company logo at registration, awards dinner recognition, and a gift bag for each player.

Silver Sponsor $4,000 Includes (1) golf foursome , hole sign and a gift bag for each player.

Beverage Cart Sponsor $1,000 Company name on cart signs.

Single Player $800 Includes a gift bag.

Sponsor Hole Sign $400

Cocktails & Dinner $300

Total $____________

Registration Form

9th annualF. Keane eagenDiabetes golf ClassicMOnDay May 17, 2010