Event Registration

Event:

April Networking After Hours

Date:

Wednesday, 21 April 2010

Time:

6:00pm till 7:30pm

Venue:

Display Networks

Price per member:

10.00

Price per visitor:

20.00

Your Details

Title:

First name:

Last name:

Organisation:

Phone:

Email address:

Address:

Guest Details

Number of members:

0 1 2 3 4 5 6 7 8 9 10

Number of non-members:

0 1 2 3 4 5 6 7 8 9 10

Guest details:

Please use one line for each guest and enter the information in the following format:
Guest Name 1, Company Name, Phone Number
Guest Name 2, Company Name, Phone Number

Payment Details

Comments: