Requested Registration for Monthly Meetings

»Request registration online using this form then contacting the person below in reference to payment;

»or register by printing this form, then completing and mailing it with payment to:

Rick Pezzullo
PMA New England District
38 Dimond Ave.
Bristol, RI 02809
rickpezz@cox.net

Cancellations must be made 24 hours prior to event to receive refund.

Please fill out this form for each foursome wishing to attend.

Requested Registration for the ANNUAL GOLF OUTING

Company Information:
*Company
*Company Membership Status	Member Nonmember
*Company Address
Company Address
*Company City
*Company State/Province
*Company ZIP/Postal Code
*Company Country
*Company Phone
Company Fax
*E-mail
(A copy of this request for registration will be sent to the provided e-mail address. If you do not receive it within 24 hours, please contact Renee.)

Golfer Information:
Golfer #1
*Name
*Event
*Relationship
Golfer #2
*Name
*Event
*Relationship
Golfer #3
*Name
*Event
*Relationship
Golfer #4
*Name
*Event
*Relationship

Special Arrangements/Requirements

Yes, our company would liek to donate the following door prize:
Gift Certificate Golf Equipment, Apparel Other