To reserve your space, please fax the following information (or click here to download and print) to Kelly Quigley by July 10 (Fax: 312-329-8811; this is a private and secure PC Fax) or print and mail this information to Kelly Quigley, 430 N. Michigan Ave., 9th Floor, Chicago, IL 60611-4087
BANQUET REGISTRATION
Name(s):
Title(s):
Company:
Street Address:
City, State, ZIP:
Daytime phone:
E-mail address:
Number of people attending with your party: ___ Members ___ Non-Members
Payment
$85 for each member (spouse/guest may attend at member rate);
$95 for non-members
___ My check, payable to ASBPE Chicago Chapter, is enclosed
Type of credit card (Visa, MasterCard, American Express)
Full Name, as it appears on card:
Credit card number:
Expiration Date:
Signature:
_____________________________________________________________________________________________
Questions? Contact chicago Chapter President Renee Pas at reneepas@ameritech.net or 630/832-8313. Please remember to save a copy of this form as your receipt
Labels: ASBPE Chicago chapter, Azbee Awards
