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Club Venetian
                                                                     29310 John R, Madison Heights, MI 48071

                                                                                  Tuesday, October 11th

           LBN                                                                             8:00 AM – 12:00 PM
                                                                                                This Event Sponsored by:

              Fall
             Mixer
                   Please 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 Oct 3rd:                                                        $10.00
      - 4 hours of Networking
      - Continental breakfast for 1 person                        Name of Staff:             
      - 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 Oct. 7th.
                                    No cancellations after that date. No-shows will be billed
                                           FOR ADDITIONAL INFORMATION CALL (248) 620-6320

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Registration Form Fall 2011 Online

  • 1. Club Venetian 29310 John R, Madison Heights, MI 48071 Tuesday, October 11th LBN 8:00 AM – 12:00 PM This Event Sponsored by: Fall Mixer Please 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 Oct 3rd: $10.00 - 4 hours of Networking - Continental breakfast for 1 person Name of Staff:       - 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 Oct. 7th. No cancellations after that date. No-shows will be billed FOR ADDITIONAL INFORMATION CALL (248) 620-6320