Phi Sigma Gamma Osteopathic Fraternity

 

WE NEED YOUR HELP!

 

 

 

We need your financial help!  Please help us restore and maintain the Phi Sigma Gamma Fraternity House.

 

 

 

_______   Yes, I want to help.  Enclosed is my financial donation (please make checks payable to
                 Phi Sigma Gamma).

 

_______   Yes, I can donate building materials.  Please contact me with more information.

 

 

 

To ensure that Evening Report continues to be a big success, we would be honored if you would present case(s) at any of our Evening Reports to be scheduled sometime in the near future.

 

 

_______   Yes, I would like to present at an Evening Report.  Please contact me with details.

 

 

Anticipated subject material: ___________________________________________________________

 

 

_______   Yes, I am interested in attending an Evening Report, but not presenting any material.  
                 Please contact me with more details.

 

 

Name: ____________________________________________ PCOM Class Year: _______________

 

Address: _________________________________________________________________________

 

City, State, Zip: ____________________________________________________________________

 

Day Telephone: _____________________________ Evening Telephone: _______________________

 

Fax Number: _______________________________ Email Address: ___________________________

 

Medical Specialty: ___________________________________________________________________

                                 Mail to:    Phi Sigma Gamma Osteopathic Fraternity
                                                 270 West Walnut Lane
                                                 Philadelphia, PA 19144