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5th Annual Harry Rozmiarek Memorial Golf Outing Registration Form

Details: Wednesday, September 20, 2017 at the Fox Hollow Golf Club located at 2020 Trumbauersville Rd, Quakertown, PA 18951.



Please use the form below to register yourself or your team for the event. Event sponsorship and additional lunch tickets can also be chosen below. The golf fee also includes a golf cart and a lunch for each golfer.


I AM (Check all that apply):(*)





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INDIVIDUAL REGISTRATION


Name (Individual Registration)

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Desired Team Members (If you do not have a complete team, please indicate who you would like to golf with or we will pair you with other individuals.)

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Email Address (Individual Registration)

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Phone Number (Individual Registration)

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TEAM REGISTRATION


Team Name

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Captain Name

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Captain Email Address

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Captain Phone Number

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Golfer #2 Name

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Golfer #2 Email Address

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Golfer #3 Name

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Golfer #3 Email Address

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Golfer #4 Name

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Golfer #4 Email Address

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SPONSORSHIPS


I would like to sponsor the following:






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Organization Name

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Contact Name

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Contact Email Address

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Contact Phone Number

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LUNCH ONLY TICKETS ($45. INCLUDED in registration fee if you are golfing)


Name (For Lunch Only Ticket)

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Company (For Lunch Only Ticket)

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Email Address (For Lunch Only Ticket)

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# of Lunch Tickets Requested

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After submitting this form, please send a check or use the "Donate Now" or "PayPal" button on the left side of our website to pay for your registration or sponsorship.



PAYING ONLINE: Option 1). After submitting this form, send payment through PayPal to psbr@psbr.org. Option 2). After submitting this form, click on the "Donate Now Using Just Give" button on our website to submit your payment. Type in your registration amount and in the Program section, please choose "Harry Rozmiarek Memorial Golf Outing" from the drop-down menu. *Note: You will have the option to pay the credit card processing fee to ensure the full amount is sent to PSBR. (Do not forget to submit this registration form)



PAYING BY CHECK: If you would like to pay by check, please make the check out to "Pennsylvania Society for Biomedical Research." Please mail the check to PSBR at the following address: PSBR, PO Box 1163, Camp Hill, PA 17001. (Do not forget to submit this registration form)


For security purposes, please type the letters you see below.(*)

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