Speed Business Networking
Event Registration

Speed Business Networking Event Registration

To register for the next Speed Business Networking event and take advantage of the exciting opportunities being made available, please fill in the form below and send via fax or mail. The attendance fee is $35 per person, and just $17 for members.

Contact Information
	Company Name
	Contact Name
	Email
	Phone Number
	Fax Number
	Street Address
Event Information
Please register me for the Speed Business Networking meeting at the location selected below:
	Number of tickets
	Event Date
	Event Location
Event Attendee Details
Please enter the name/s of people that will be attending the Speed Business Networking event:
	Persons to attend:
Billing Address
	Billing Address
	City
	State
	Postal Code
	Country
Credit Card Information
	Card Type
	Card Number
	Card Security Code	not sure what this is??
	Expiration Month
	Expiration Year
Payment
	I authorise Speed Business Networking to register me for the above event. I further affirm that the name and personal information provided on this form are true and correct. Signature: _____________________________________ Date: ___________________ I agree to pay Speed Business Networking the per person event fee. No booking will be accepted without payment in advance. This form may be faxed to+ 61 (8) 9246 1966 or mailed to PO Box 2018, Warwick WA 6024. The above amount includes GST, and this form serves as your tax receipt.

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