Conference Mail-In Registration Form

 

Print out this form and mail or fax it to:

Long Beach Nonprofit Partnership

3635 Atlantic Ave.

Long Beach, CA 90807

FAX: (562) 290-8018

You are not considered enrolled until we have received payment. You are responsible for payment to the LBNP unless you cancel your registration at least ten working days before the event.

 

Name ___________________________________________________________________

Title ___________________________________________________________________

Organization _____________________________________________________________

Address _________________________________________________________________

Phone (   ) _________________________

Fax (   ) _______________________

E-mail ____________________________________

Website address_______________________________________

Total Enclosed $_______________ Check # ________________

LBNP Member? ____________