Wednesday, April 21, 2010
11:45 a.m.
Port Washington 

$10 Chamber members , $15 future Chamber members
Advance registration and payment is required by 4/15

Business __________________________________________________

Attending ____________________________

                 ____________________________

# at $10.00 __________   # at $15 __________  = Total __________

Check payable to PWCC  ___

Master Card ___

Visa  ___

Name on card _____________________________________________
Card Number ______________________________________________

Expiration Date __________  Security Code _________

Phone Number _________________________________
Amount to be charged $____________

Signature __________________________________________________