Name: Organization: - Microsoft · Name of ard Holder: _____ If you need an auxiliary aid in order...
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Please return this registraon form with payment to: Kaua'i Chamber of Commerce P.O. Box 1969 Lihu'e, HI 96766 Fax to: 245-8815 Online: www.kauaichamber.org More info call: 245-7363 No Refunds or Cancellaons aſter October 18, 2017 No Shows will be charged Name: ___________________________ Organizaon: _____________________ Name: ___________________________ Organizaon: _____________________ Reservaons: ________ x $ 15 = ________ Chamber/KCFB Members ________ x $ 25 = ________ Non members (includes pupu, refreshment, and movie cket) Please provide the names of your guests on a separate paper, or email Anna at [email protected] Circle Method of Payment: □ MasterCard □ Visa □ Check □ Cash Credit Card Number: _________________________________________ Exp: _____ / ______ Name of Card Holder: _________________________________________________________ If you need an auxiliary aid in order to parcipate (ASL Interpreter, caponing, materials in an alternate format, other assistance) please call Carol at 245-7363 or email [email protected] at least five working days before the event. Sponsored by
Transcript of Name: Organization: - Microsoft · Name of ard Holder: _____ If you need an auxiliary aid in order...
Please return this
registration form with
payment to:
Kaua'i Chamber of Commerce
P.O. Box 1969
Lihu'e, HI 96766
Fax to:
245-8815
Online:
www.kauaichamber.org
More info call:
245-7363
No Refunds or
Cancellations after
October 18, 2017
No Shows will be charged
Name: ___________________________ Organization: _____________________
Name: ___________________________ Organization: _____________________
Reservations: ________ x $ 15 = ________ Chamber/KCFB Members
________ x $ 25 = ________ Non members
(includes pupu, refreshment, and movie ticket)
Please provide the names of your guests on a separate paper, or email Anna at [email protected]
Circle Method of Payment: □ MasterCard □ Visa □ Check □ Cash
Credit Card Number: _________________________________________ Exp: _____ / ______
Name of Card Holder: _________________________________________________________
If you need an auxiliary aid in order to participate (ASL Interpreter, captioning, materials in an alternate format, other
assistance) please call Carol at 245-7363 or email [email protected] at least five working days before the event.
Sponsored by
