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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:

Dietra Rosenkoetter
PMA Indiana District
Account Manager
Manufacturing Extension Partnership Center
Purdue University - TAP
6640 Intech Blvd., INTECH 10; Suite 120
Indianapolis, IN 46278-2012
Phone: 317-275-6812
Fax: 317-275-2375
dietra@purdue.edu

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

Requested Registration for the PMA 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
*Name
*E-mail

Golfer Information
I wish to reserve a foursome slot now and enter names later
Total number of foursome slots:
Total players:

I wish to reserve a foursome slot for the following golfers
Player #1:
Dinner:	Yes No
Player #2:
Dinner:	Yes No
Player #3:
Dinner:	Yes No
Player #4:
Dinner:	Yes No

I wish to reserve a slot for the following golfers to be placed in foursomes as needed
Player #1:
Dinner:	Yes No
Player #2:
Dinner:	Yes No
Player #3:
Dinner:	Yes No
Player #4:
Dinner:	Yes No

Donations & Sponsorships
I want to: donate door prizes; sponsor a hole; sponsor a beverage cart!

(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 Dietra.)

Special Arrangements/Requirements

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