Print this page. To Register fax this form to 800 852 8610, or call 877 247 0307, or print and mail it to Omni Publishing Co. P.O. Box 640, Wareham, Ma 02571.www.omni-pub.com Please register _______person(s) for the Entrepreneurship as a Second Act Seminar to be held at: Date: Sept 20, 2008 Time: 9am-1pm Price: $125 per person Name______________________________________________________________ Department_________________________________________________________ Organization_______________________________________________ Address_____________________________________________________________ CITY________________________________STATE________________ZIP______ Method of payment : ( ) Bill my Department ( ) Check Enclosed ( ) Visa/MasterCard ( ) Purchase Order CC# or PO# ___________________________________Expiration Date_________________ BILL TO: Name______________________________________________________________ Department_________________________________________________________ Address_____________________________________________________________ CITY________________________________STATE________________ZIP______ Print this page. |