Professional Roundtable Event Registration Form

No Charge to Attend But Advance Registration is Required

I would like to attend the roundtable event on:

Friday 3/19/2010 8:00 AM · Hampton Inn · 120 Jericho Tpke, Jericho

First Name: *

Last Name: *

Company: *

Email Address: *

* Minimum Required Entry

Your badge will be printed with your name and company name as entered above

Comments, Feedback, Requests, and Suggestions...

First Time Attending...

 If you've never registered for any Professional Roundtable event before, you must fill in ALL fields below:

Address:

City:

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Phone:

Referred by
       or Guest of:

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Profession:


 

Attorney

 Banker

CPA

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