REGISTER BY FAX FOR A Power of Angel Investing SEMINAR
Complete the following (including credit card information), print the file, and FAX it to our registrar at 336.315.7562. Please phone Jamie Petherbridge, our registrar, at 336.315.7521 if you have questions.
I will attend the Power of Angel Investing seminar in: SEMINARS: Fayetteville (5/25-25)
Please indicate marketing partner affiliation (to be eligible for the $100 registraton fee discount):
CHOOSE ONE: Womble Carlyle Sandridge & Rice Tippett, Padrick, Bryan, Merritt & Raynor First Citizens Bank Williform McCauley Daniels, Daniels & Verdonik Cumberland County Business Council Inception Micro Angel Fund (IMAF) Angels for Moore Piedmont Angel Network (PAN) ENC-Investors Network TIG IV Kilpatrick Stockton Triangle Accredited Capital Forum
In registering for this seminar, I certify that I am an SEC-accredited investor: a net worth of $1 million or an annual income in excess of $200,000 (with spouse, in excess of $300,000). (my initials)
FIRST NAME:
LAST NAME:
TITLE:
COMPANY:
ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
E-MAIL ADDRESS:
Please use VISA or MasterCard only
It is mandatory that you complete the following credit card information if you want to register by FAX for this seminar.
Card type: VISA MasterCard
Card #
(By indicating a marketing partner above, your fee for this seminar will be $295)
Expiration date:
Name on card:
Typed signature:
(NOTE: Statement will list payment to "UNC CH SM BUS TECH POS")
