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REGISTRATION FORM Please reply by Thursday, April 11, 2013

Event Schedule Saturday, April 20 2013 The Willows WHEN 7-7:45 a.m. 8 a.m. 8:15 a.m. 11 a.m.-1 p.m. 12-1 p.m.

Check one: Registration and Breakfast Safety Course Flight Lunch Door Prizes and Awards

Top shooters will be recognized at the award ceremony. Prizes

Each shooter receives 1 door prize ticket for a chance to win a valuable door prize.

Please bring the following:

• 12 or 20 gauge shotgun; please note that you must provide your own shells • Eye protection (required) • Hearing protection will be provided. Guns and eye protection can be rented from the Willows, but arrangements MUST be made in advance.

Registration Individual: $125 Individuals will be assigned a team • Welcome pack • Drinks (water, soda) • 100 rounds of clays • One door prize ticket • Breakfast, lunch • T-shirt

Team: $500 Includes all items listed above for each of four team members

Gold Sponsor: $1,500

• 1 Shooting Team of four • Signage on the Willows Course • Company Logo prominently featured on the back of commemorative t-shirts • Recognition in the Community Foundation of Northwest Mississippi annual report

Silver Sponsor: $750

• 1 Shooting Team of four • Signage on the Willows Course • Company Logo prominently featured on the back of commemorative t-shirts.

Individual: $125

Team: $500

Sponsorships Gold: $1,500 Silver: $750

Individual Name or Company Name: __________________________________________________________________________________ Contact Name for Team: ____________________________________________________________ E-mail Address: ____________________________________________________________________ Address: __________________________________________________________________________ City/State/Zip: ____________________________________________________________________ Phone: ( ) ___________________________ Individual Team Member Information Please indicate shirt size (L,XL, XXL) Names: 1) ___________________________________________________________ Size: ________________ 2) ___________________________________________________________ Size: ________________ 3) ___________________________________________________________ Size: ________________ 4) ___________________________________________________________ Size: ________________ Payment Information Registration fee: ________________________ Guest Meal Tickets*: _______ @ $20 each= ____________ Total: __________________________________ *Meal tickets will also be available for purchase at the tournament.

Check enclosed payable to Community Foundation of North Mississippi Please charge my (circle): MasterCard Visa American Express Card # _______________________________________ Exp.__________________

Print Name on Card ______________________________ Signature ________________________


Shoot for the Heart

Paper Packers Sporting Clays Club

One Patient’s Lasting Gift

In 1999, just one month after Keith Wilson was transferred to Nashville for work, he became a patient at Saint Thomas Hospital and learned that he would need open heart surgery. After a successful surgery and intensive rehabilitation, Keith returned to work and normal daily activities.

presents the

2nd Annual

Having to undergo major cardiac surgery is an extremely difficult experience, but for Keith, it was also a defining one. He wanted to express his gratitude to Saint Thomas’s dedicated staff in a way that would allow other heart patients to receive the same expert care he did. An avid sporting clays enthusiast, Keith organized and led a sporting clays tournament in April 2001, inviting the support of his local sporting clays teams, friends and coworkers.

Local

The tournament, called Shoot for the Heart, was highly successful and became an annual event. Countless cardiac patients have been served through the generosity of its sponsors and participants. For the third consecutive year, the corporate event will also assist Northwest Mississippi Community College School of Nursing as it prepares more health care leaders.

April 20, 2013

Willows Sporting Clays Center Tunica, Mississippi

For more information, contact: Shoot for the Heart Community Foundation of Northwest Mississippi

315 Losher St. Suite 100 Hernando, MS 38632 Phone: (662) 449-5002 Fax: (662) 449-5006 www.cfnm.org

Tournament organizers have found a college in the region that is increasing the number and quality of nurses to care for cardiac and other patients more effectively. Northwest Mississippi Community College’s Division of Nursing moved into a top-notch new facility in April 2011 that enables it to prepare more nurses to serve the growing health needs of this region. With a degree from this college, graduates are prepared to become Registered Nurses. Fundraising events like Shoot for the Heart provide the kind of equipment, instruction and scholarships needed to prepare these nurses for health care leadership in Northwest Mississippi.

An Event Benefitting Northwest Mississippi Community College Division of Nursing 4975 Highway 51 North Senatobia, MS 38668

Nursing at Northwest

Northwest Mississippi Community College

Division of Nursing


Shoot for the Heart Registration Form