Women in Business

Event Registration

Name(Required)

First Last

Email(Required)

Are you a Member?(Required)

Yes

Membership ID

Number of Guests in Your Party

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Event

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Paid Event?

Paid Event

Only fill out this portion of the form if the event is a paid event

Card Type(Required)

Visa

Mastercard

American Express

Discover

Name on Credit Card(Required)

First Last

Credit Card Number(Required)

CC Expiration Date(Required)

CVV(Required)