REGISTER BY FAX FOR A Power of Angel Investing SEMINAR                 

  Complete the applicable information, print the file, and mail it (with your check attached or with the credit card information below complete) to our registrar:

Jamie Petherbridge/SBTDC
115 Pomona Drive; Ste. A, Greensboro, NC 27407-1617

Please phone Jamie Petherbridge, our registrar, at 336.315.7521 if you have questions.

I will attend the Power of Angel Investing seminar in:

Please indicate marketing partner affiliation (to be eligible for the $100 registraton fee discount):

        

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're not paying by check yet want to preregister for this event.

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 "University of North Carolina at Chapel Hill")