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Golf Registration Form

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Golf Registration Form

PENINSULA REGIONAL MEDICAL CENTER FOUNDATION

2013 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, 2013.

Click here to see Sponsorship Details
* Indicates required information
I would like to be a sponsor of the 2013 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 2012 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. 
Select Payment Type: * 
Name as it appears on card 
Card Number: 
Exp. Date: 
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 
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