Golf Scramble Registration Form

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					                                                                      2011 MEMA Convention
                                                             Golf Scramble Registration Form
                                                                      Monday, June 20th, 2011
                                                                        Tee Off: 11:00am


                                                                                             SPONSORED BY:
Please complete the following:


Company ______________________________________________________________

Contact ________________________________________________________________

Address ______________________________________________________

City _________________________ State _________Zip_______________

Telephone __________________________

Email ___________________________________________

Player Names:
_______________________________               ________________________________

_______________________________               ________________________________

_______________________________               ________________________________

The per player fee for participation in the Golf Scramble is $125.00. This fee includes greens
fees, golf cart, and boxed lunch.

       Number of Golfers: __________ x $125.00 = $_____________

Payment Method

   Check Enclosed

   Visa

   Mastercard

________________________________                      ________________
Credit Card #                                         Exp. Date

_______________________________________________
Signature



                                   PLEASE FAX TO MEMA AT 207- 721-9227

				
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