Peninsula Regional Medical Center - Part of Peninusula Regional Health System


Online Golf Registration Form


PENINSULA REGIONAL MEDICAL CENTER FOUNDATION

15th Annual Golf Classic

Registration is complete upon receipt of completed form and payment of sponsorship.
Registration for sponsorships is on a "first-come, first served" basis.
No rain date and no refunds after September 1, 2014.

Click here to see Sponsorship Details



* Indicates required information
I would like to be a sponsor of the 15th Annual Golf Classic 
Name:  * 
Business: 
Street Address 1 
Street Address 2 
City 
State 
Zip 
Email: * 
Phone: * 
Fax: 
 
Sponsorship Commitment (please check one) * 






Select this option if you would like to use your 2013 ad again this year. 
Please list Sponsored Golfers by Team with Names and Individual Handicaps 
Team 1 (4 golfers with individual Handicaps) 
Team 2 (4 golfers with individual Handicaps) 
Additional Golf Registrations @ $500 per person. 
Amount of donation: * 
 
If you prefer to pay by check, use the information below 
Make check payable to: Peninsula Regional Medical Center Foundation, Inc. 
Mail to: Peninsula Regional Medical Center Foundation, Inc. 100 East Carroll Street Salisbury, MD 21801 Attn: Denise Billing, President 
For Additional Information, please call 410-543-7140 or Email Us 
Payment Information
Amount
Authentication * 

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