1st Annual Capital District Golf Outing
                              Thursday, April 30, 2009
                                Groff's Farm Golf Club, Mount Joy, PA
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                                Pre-Registration - By Mail

Pre-registration by mail with payment by check or money order must be postmarked by 4/23/09.  Registration fee is $55.00 per person and includes a round of golf, cart, snacks, dinner and prizes!

To register by mail, print out this form, complete it and mail it along with a check payable to the "PSRC" to:

PSRC Capital District Golf Outing
c/o 225 Hampshire Drive
Sellersville, PA 18960-2876


Name_________________________________     

Address___________________________________________________________

City _______________________________ State___________ Zip_____________

Telephone (Day) ___________________ E-mail ____________________________

Hospital/Business Affiliation_______________________________________

Job Title:  ____________________________________________________


If registering more than one golfer, enter additional information below:

Name #2 _________________________________    Email or Phone:_____________________

Name #3 _________________________________    Email or Phone:_____________________

Name #4 _________________________________    Email or Phone:_____________________




Questions? Send an email to ExecutiveDirector@psrc.net