ENGINE COMPANY 15 Fredericktown, Pa

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REGISTRATION FORM: Please return this portion with payment

Company: ___________________________________________________ Phone: _____________________


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Street City State Zip Code


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Contact Person


I wish to participate as follows:

______ Gold Sponsor @ $1500 ______ Silver Sponsor @ $ 1250 _______
Fireman’s Friend @ $ 500

______ Premium Tee Sponsor @ $200 _______ Standard Tee Sponsor @ $100

______ Foursome @ $300 / per foursome _______ Individual Golfer @ $75 /each

______ Texas Steak Barbeque Only $40


Reservations call Mark at 724-678-5267 or John at 724-377-1156 or Nicholas ay 724-377-0647

Make checks payable to: East Bethlehem Township VFC

Mail to: EBVFC “Strive to Survive” PO Box 445 Fredericktown, Pennsylvania 15333

All Gold and Silver Sponsor Reservations must be made by July 30th, 2009
Gold & Silver Sponsors can also reserve additional foursomes prior to September 1st if available
Open to foursomes and individuals: RSVP opens June 1st, 2009
Golfer’s names must be submitted in by August 1st, 2009

TEAM # 1 (Gold & Silver)                                                     TEAM # 2 (Gold)

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Any problems copying the above form call one of the above phone numbers!