Wednesday, May 19, 2010
11:45 a.m.  Nisleit's Country Inn

3704 Highland Dr., Port Washington

$10 Chamber members
Advance registration and payment is required by 5/17

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 __________________________________________________