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Club Venetian                                                                     29310 John R, Madison Heights, MI 48071 ...
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Registration Form Fall 2011 Online

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Flyer for fall mixer

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Registration Form Fall 2011 Online

  1. 1. Club Venetian 29310 John R, Madison Heights, MI 48071 Tuesday, October 11th LBN 8:00 AM – 12:00 PM This Event Sponsored by: Fall Mixer Please complete all four sections below to make your reservation1. Name:       Company:       Phone: (     )     -      Email:      Business      Category:LBN Chapter:      Non-Members: Name of LBN Member who invited you:      2. Exhibitor: Exhibitor 4’ Table LBN or FON Member: $50.00- Table top presentation space Non-Member: $75.00- Table and cover Exhibitor 8’ Table LBN or FON Member: $80.00- 4 hours of Networking Non-Member: $105.00- Continental breakfast for 1 person Electricity Needed: $0.00- Electricity if ordered Offering Door Prize: $0.00- Door Prizes *Add $10 late fee if registering after Oct 3rd: $10.00 - 4 hours of Networking - Continental breakfast for 1 person Name of Staff:       - Door Prizes Email:       Non-Exhibitor: - 4 hours of - Door Prizes Non-Exhibitor: $15 each Networking - Continental breakfast for 1 person Lunch & Networking: - 12:15 pm – 2:00 pm Total Lunch price ($20 per person):       - $20 per person *If person attending lunch is different than or in addition to those named above, please call 248-620-6320.3. PAYMENT CHECK CREDIT CARD Total Amount:       OPTIONSCARD TYPE: VISA M/C DISCOVER AMERICAN EXPRESSName as it appears on card      Billing Address                      STREET CITY STATE ZIPCard Number       -       -       -       Security Code:     Expiration Date:    /     Signature      Date     4. To complete your reservation, do one of the following: - Mail form with your check made out to LBN: Local Business Network - Sign up online at www.LocBusNet.com 5446 Bristol Parke Dr. - FAX form with payment info. to (248) 620-6321 Clarkston, MI 48348 *All reservations must be received by Oct. 7th. No cancellations after that date. No-shows will be billed FOR ADDITIONAL INFORMATION CALL (248) 620-6320

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