Requested Registration for Monthly Meetings

»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:

Lisa Rossman
PMA Wisconsin District
W237 N2889-A Woodgate Rd.
Pewaukee, WI 53072
Phone: 262-523-1800
Fax: 262-523-1818
lisa@wellerusa.com

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

Requested Registration for the 14th Annual Golf Outing

Company Information:
*Company
*Company Membership Status	Member Nonmember
*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 Lisa.)

Sponsorship Opportunities:
Beverage Cart Sponsor $250	Driving Range Sponsor $150
Bag Drop off Sponsor $250	Hole/Tee Sponsor $100
Registration Sponsor $150	Colored Ball Sponsor $50

Golfer Information:
Golfer #1
*Name:
*Title:
*E-mail:
Golfer #2
Name:
Title:
E-mail:
Golfer #3
Name:
Title:
E-mail:
Golfer #4
Name:
Title:
E-mail:

Special Arrangements/Requirements