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 __________________________________________________