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Player Registration

Reserve your spot now! All fees include continental breakfast, participation in the Healthcare Golf Classic (golf cart & green fee included), luncheon, and awards ceremony for those registered.

A place will be reserved for you when we receive this online form, and you will be officially registered as soon as we receive your check, made out to Franklin Community Health Network. Mail your check to:

Healthcare Golf Classic
Franklin Community Health Network
111 Franklin Health Commons
Farmington, ME 04938

Or, register and pay immediately with your credit card, by printing out andFAXING back our Fax Back Registration Form (this is in PDF format, for which you will need to download Adobe Acrobat Reader, if it is not already installed on your computer.)

For more information, contact us.

Your Name

Your Email

I would like to be a hole sponsor ($350)

I would like to sponsor a team of four players ($700, includes up to 4 players participating)

I would like to sign up individual player(s) ($150, please put me/us on a team)

I would like more information about sponsorship (someone will call me)

I would like to donate the following prize(s) to the tournament (please list and indicate value--someone will call me):

Sorry I can't play, but please accept my tax-deductible contribution of
$

Please provide information for each player you are registering:

Player 1:

First Name

Last Name

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Work Phone

Home Phone

E-mail

Handicap

Player 2:

First Name

Last Name

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Work Phone

Home Phone

E-mail

Handicap

Player 3:

First Name

Last Name

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Work Phone

Home Phone

E-mail

Handicap

Player 4:

First Name

Last Name

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Work Phone

Home Phone

E-mail

Handicap

First Name
Last Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
E-mail
Handicap