5th Annual Golf Classic Registration Form:

Print, fill out and mail this form by October 1, 2002.

Name
______________________________________

Firm
______________________________________

Address
______________________________________

City/State
______________________________________

Zip Phone
______________________________________

E-mail
______________________________________

Please assign me to a foursome.

Request for foursome (if any)
1____________________________________

2____________________________________

3____________________________________

4____________________________________

I would like to attend as a Patron. Enclosed is my check for $50.00.

Yes, I/ my firm will be a sponsor:

Sponsor type.
______________________________________

Please print how name should read for signage.
______________________________________

I will donate these items to be raffled off or given away. Please list.
______________________________________

______________________________________

______________________________________

______________________________________

I cannot attend the event, but please accept my donation of
$____________________________________

Total enclosed
$____________________________________

Please return this form with check payable to:
HLA Lacrosse Foundation
33 Old Windybush Road
New Hope, PA 18938
215.862.9355