Requested Registration for Golf Outing

»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:

Roxanne Memmolo
PMA New York/New Jersey District
Zierick Manufacturing Corp.
131 Radio Circle
Mount Kisco, NY 10549
Phone: 914-666-2911
Fax: 914-666-0216
Rmemmolo@zierickhq.com

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

Pricing: $150 / member, $175 / nonmember, per Golfer; $150 per Award or Hole Sponsorship; $250 / member, $275 / nonmember, per Supplier Table; $125 / member, $150 / nonmember, per Golfer with Supplier Table

Requested Registration for the June 26, 2008, golf outing

Your Company:
*Company
*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 Roxanne.)
Golfers:
*Golfer #1 Name
*Golfer #1 Phone
Golfer #1 Handicap
Golfer #1 Golf, Table or Hole Sponsorship	$
Golfer #2 Name
Golfer #2 Phone
Golfer #2 Handicap
Golfer #2 Golf, Table or Hole Sponsorship	$
Golfer #3 Name
Golfer #3 Phone
Golfer #3 Handicap
Golfer #3 Golf, Table or Hole Sponsorship	$
Golfer #4 Name
Golfer #4 Phone
Golfer #4 Handicap
Golfer #4 Golf, Table or Hole Sponsorship	$

Special Arrangements/Requirements

HOME | REGISTER | LINKS | CONTACT US