PLEASE COMPLETE FORM AND RETURN

IRS FORM

Member Name: Member #:

Date of Function:

Time of Function: Room:

Please Check One:

1. I will not be reimbursed for any expense of this function.

2. I will be reimbursed by other than my employer.

3. This function will serve a business, personal, or social

purpose of my own, and will be reimbursed by my employer or social club. (You must serve as an officer of the

social club in order to be exempt from room rentals)

(Please complete the following two lines of information)

Name of Employer or Club

My Position in firm or Club

Please Note: As a tax exempt/not for profit organization, The Pinecrest Country Club is required to obtain information on the source of funds received in payment for any function of eight 8 or more persons.

I have read and agree to the terms and conditions of the attached banquet guidelines and function sheet. I also agree to provide a typed copy of the names and addresses of all guests attending the above function.

Member Signature: