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Registration Form Winter 2011
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 reservation
1. 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 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 February 11th.
No cancellations after that date. No-shows will be billed
FOR ADDITIONAL INFORMATION CALL (248) 620-6320