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Home Improvement Event Registration (Per Person)
Thank you for your interest in participating. Please fill in and submit the form below and return it to Home Improvement Entrepreneur by mail or fax. Please note that all information above the line is required. A separate registration is required for each person attending. Payments must be received at least 5 business days prior to the event. Your event ticket will be faxed or emailed to you upon receipt of payment. Mail or fax to
Home Improvement Entrepreneur 460 Briargate Drive, Suite 400 South Elgin, IL 60177 Fax: 847.695.0788 Ticket Type:
_____Free Member Ticket— one free ticket per member company ($0)_____Half-Price Member/Sponsor Ticket— half-price ticket per member or sponsorednonmember (@$447.50) (Be sure to include sponsor code below.) _____Full-Price Nonmember Ticket— full price tickets for nonmember/unsponsoredcompanies (@$895)
Event Name _____________________ Start Date _________________________
Total Payment Enclosed $_________ Sponsor Code:__________________________
First Name _______________________ Last Name ___________________________ Organization______________________ Position/Title__________________________ Address ______________________________________________________________ City _____________________________ State ______ Zip____________ PH-Company _____________________ PH-Cell ______________________________ PH-FAX_________________________ Email ___________________________ Website ______________________________ Company’s Approx. Annual Business _____________________________________ Products Marketed: _____Windows _____Siding _____Doors _____Roofs _____Basement System _____Gutters _____Gutter Prot. _____Decks _____Sunrooms _____Tub Liners _____Other (explain): ________________________ Credit Card: ___MC ___Visa ___AMEX ___Discover
Card No.:________________________ Card Exp.: _ _ /_ _ CID No.: ________
Cardholder Name_______________________
Cardholder Signature___________________________________
Please use one form for each individual requesting a ticket. |