REGISTER by mail
Please complete this form, print it, and mail it (along with either the credit card information completed or a check for the total amount below) to:
Please call John at 919.962.8297 should you have questions.
FIRST NAME:
LAST NAME:
BUSINESS AFFILIATION:
TITLE:
NAME ON NAMETAG:
BUSINESS ADDRESS:
CITY:
STATE:
ZIP:
BUSINESS PHONE:
E-MAIL ADDRESS:
I wish to register for the free SBIR Introductory session (8-9:15am)
Please use VISA or MasterCard only
It is mandatory that you complete the following credit card information if you want to preregister for this event.
Card type: VISA MasterCard
Card #
TYPE OF REGISTRATION:
CHOOSE ONE: Full-day (including lunch) @ $75 Afternoon workshop only @ $60
Expiration date:
Name (on card):
Typed signature:
(NOTE: Statement will list payment to "University of North Carolina at Chapel Hill")
