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Event Name:
Event Date
Contact Person:
Contact Phone Number:
Email Address:
Organization:
Address:
City:
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People Attending:
Name
Are you Member of HPRMA?
Yes
Yes
Yes
Yes
Yes
Yes
Payment Type:
Visa
Master
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Exp Date:
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MM/YYYY
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Per-Person Event Fee:
Member--Prepaid-- $20
Non-Member--Prepaid-- $25
(No-shows will be billed.)
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