REGISTRATION FORM

Attendees

Please fill out the information for each person attending below.

Guest 1	First Name	Last Name	Title

Guest 2	First Name	Last Name	Title

Guest 3	First Name	Last Name	Title

Guest 4	First Name	Last Name	Title

Contact Information

Please fill out the information for the main contact who is registering.
Fields marked with a dot (°) are required.

Contact (Full Name) °	Phone Number °	Email °

Company Name °

Address 1 °

Address 2

Billing Address (if different)

Method of Payment

Please choose your method of payment below. Credit card payments will be processed by phone through the Salisbury Area Chamber of Commerce 410 749-0144

CreditCard - by phone

Check - by mail

Bill Me - invoice by mail

Cost is $145 for Early Registration by Feb. 29, 2008
After Feb. 29 cost is $185

No refunds after April 4, 2008

If you need an accommodation to attend, please e-mail us at register@diversitysummit.esbln.org by March 26 with your request.

Once you hit send and the form is processed, you will receive confirmation and further instructions for making payment.