Event Registration Form
PRINT and MAIL to the Rotary office with your check or
FAX with your Credit Card Information
|
| Event I'm registering for : |
_____________________________________ |
Full Name (Required):
|
__________________________________________
|
| Guest Name(s): |
__________________________________________
__________________________________________
__________________________________________
__________________________________________ |
|
Company Name:
|
__________________________________________
|
|
Email Address (Required):
|
__________________________________________ |
|
Work Phone (Required):
|
_________________________
|
| Fax: |
_________________________ |
| Home Phone : |
_________________________ |
| Credit Card Type (Circle one) : |
Visa MasterCard AmEx |
| Name on Card (Required): |
__________________________________________ |
| Card Number Required): |
__________________________________________ |
| Expiration Date (Required): |
_________ Month __________Year |
| |
|
|
Comments or
questions:
|
______________________________________________________________
______________________________________________________________
______________________________________________________________ |
If you're paying by credit card, FAX this form to:
(864) 235-3328
If paying by check, MAIL to: P.O. Box 3537 Greenville, SC 29608
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