2. ASHRAE FALL OUTING SIGN‐UP SHEET
Please complete this sheet electronically and e‐mail it to jkurcz@midwestapplied.com.
If you choose to pay by check please fill out this form and e‐mail—jkurcz@midwestapplied.com, fax—708‐540‐
4556, or send it to the address listed below. Please make all checks payable to Illinois Chapter ASHRAE for the full
amount of your group’s fees. Checks should be mailed to:
ASHRAE Fall Outing
c/o Midwest Applied Solutions, Inc.
30 N. Wolf Rd, First Floor
Hillside, IL 60162
Attn: Joe Kurcz
Please be sure to check the box marking your interest in either Golf or
Dinner Only. Companies that wish to make group reservations for
more than 2 foursomes should contact Joe Kurcz, golf outing chairman,
for special reservation instructions and assistance.
Single, twosome, and threesome golfers please mention if your name/group
is to be coordinated with Joe Kurcz—708‐540‐4555.
Organization:_______________________________________
Non‐Golfer
Golf Dinner Only
$160/ea $60/ea
Name(s): __________________________________________
__________________________________________
__________________________________________
__________________________________________
Group Contact Name:__________________________________________
Phone:____________________ Fax:____________________________
Payment Options:
My check for $______ is enclosed.
Please charge my credit card: American Express MasterCard VISA
Credit card number: ______________________________________
Expires __________
Signature:______________________________________________