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Registration Form Winter 2011


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Registration Form Winter 2011

  1. 1. Club Venetian 29310 John R, Madison Heights, MI 48071 Thursday, February 17th LBN 8AM to Noon JOIN US FOR ONE OF Winter SOUTHEASTERN MICHIGAN’S PREMIER NETWORKING EVENTS MixerPlease 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 February 9thth: $10.00 - 4 hours of Networking Second Staff Member person - Continental breakfast for 1 at Exhibit: Name of Staff: 2nd Staff Member at Exhibit:       $15 each - 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:       OPTIONS CARD TYPE: VISA M/C DISCOVER AMERICAN EXPRESS Name as it appears on card       Billing Address                      STREET CITY STATE ZIP Card 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 5446 Bristol Parke Dr. - FAX form with payment info. to (248) 620-6321 Clarkston, MI 48348 *All reservations must be received by February 11th. No cancellations after that date. No-shows will be billed FOR ADDITIONAL INFORMATION CALL (248) 620-6320