2011 Golf Registration Form

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					                         The Alpha Alpha Chapter of Gamma Iota Sigma
                                           invites you to our
                              21st Annual Four-Person Golf Scramble
                                     Friday, September 23, 2011
               9:00 a.m. Registration, 10:00 a.m. Shotgun, 4:00 pm Reception & Prizes
       To bring insurance alumni, students, and professionals together for golf, food, and FUN!
                                            The Medalist Golf Club
           The Medalist Golf Club, 15701 N. Drive North, Marshall, MI 49068. Phone-269.789.4653
      Entry Fee includes: 18 holes of Golf – Golf Cart – Continental Breakfast – Lunch – Dinner and Prizes
   Proceeds used to fund the activities of Gamma Iota Sigma – educational tours, career workshops, recruiting
                                         DEADLINE AUGUST 31, 2011!!!
           Please sign-up your four-person team or sign-up individually and we'll assign you to a team
Please fill in the appropriate boxes below:
                                                                                                                OC Grad?
Captain/Contact Person:
Email Address:
Complete Mailing Address:
                                                                                                                OC Grad?
Team Member Name:
                                                                                                                OC Grad?
Team Member Name:
                                                                                                                OC Grad?
Team Member Name:

Please check the appropriate boxes below:
□ Our team would like a Gamma Iota Sigma student member to be part of our foursome
□ Our organization would like to sponsor a hole; Name to appear on sign:
□ I am already sponsoring a hole as part of this year's Gamma Iota Sigma solicitation
□ Please add my donation to the Gamma Iota Sigma Alumni Hole sponsorship
□ Our company/organization will bring door prizes
□ Sorry, I'm unable to attend this year, but want to make a tax deductible contribution to Gamma Iota Sigma
□ Individual Registration $150                       □ Foursome Registration $600
□ Hole Sponsorship $250                              □ Save $50 - Foursome & Hole Sponsorship $800
Total Amount Enclosed: $
    Please let us know if your organization matches individual donations, and provide the appropriate form if available.
             Please refer to for more information on our 2011 Golf Outing and
                for directions to the golf course.
                                 Please make checks payable to Olivet College and mail to:
           Risk Management & Insurance Center at Olivet College, 320 South Main Street, Olivet, MI 49076
                      Attn: Marie Steele, Risk Management & Insurance Center Administrator or
                                     Fax your credit card information to 269-749-7185

                             ___American Express ___Discover ___MasterCard ___Visa
Card Number:_______________________________ Expiration Date:_______ Security Code (back of card):________

Signature:________________________________________                          Amount to be Charged: $_____________

              Questions? Please call 269-749-6605 or email Tim Puffer at
                                         Thank you for your support!