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LATINA Style Business
Series Registration Form |
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* Event: |
= '$hoy'order by bs_date" ;
$query = mysql_query($sql);
while ($query_res = mysql_fetch_array($query))
{
$bsid = $query_res['bs_id'] ;
$bslo = $query_res['bs_location'] ;
$bsda = format_fecha( $query_res['bs_date'], 0, "-" ) ;
$bsdrop .= "" ;
}
?>
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Prefix: |
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First Name: |
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Last Name: |
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Company: |
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Title: |
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Address: |
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City: |
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State: |
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Zip: |
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Phone: |
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Fax: |
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E-Mail: |
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Are you a business owner? |
Yes
No
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How did you find out about
this event? |
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How long have you owned
your business? |
Years |
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Three major questions
you would like answered
on this Business Series?
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PAYMENT
OPTIONS*
Cost online: $20 - Cost
at the event: $40
Cancellations and early
bird registration
deadlines are one week
prior to event date. |
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Credit
Card Expiration Date:
-
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VIN
Number:
*number on back of card:
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*please
write it out and mail to:
LATINA Style
1701 Clarendon Blvd.
Suite 100
Arlington, VA 22209
703-312-0904 phone
703-312-7062 fax |
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*
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