2013 Golf Outing Registration Form

Date of Outing: Tuesday, May 14, 2013

Checks should be made payable to Rockland County Chapter NYSSPE, and should be mailed as indicated on the page which will be displayed upon your submission of this registration form.

Please direct any questions regarding the Golf Outing to GolfOuting@RocklandNSPE.com or you may leave a message at the chapter office at (845) 634-5307.

Name
Company
Address
Telephone number
E-mail address
Number of golfers attending
Name of golfer #1
Name of golfer #2 (if applicable)
Name of golfer #3 (if applicable)
Name of golfer #4 (if applicable)
Interested in golfing with
# of extra dinner guests NOT golfing
Fee for Golfers @ $165/each
Fee for EXTRA dinner guests @ $40/each
Fee for tee sponsors @ $125/each
Discount: 4 golfers + tee sponsor @ $725
Total fee being submitted
We would like to provide for door prizes
We would like to provide for goodie bags

PLEASE MAKE A NOTE OF THE TOTAL REGISTRATION FEE DUE PRIOR TO SUBMITTING THIS FORM!