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Club Venetian
                                                                   29310 John R, Madison Heights, MI 48071

                                                                        Thursday, February 17th
           LBN                                                               8AM to Noon
                                                                        JOIN US FOR ONE OF
          Winter                                                     SOUTHEASTERN MICHIGAN’S
                                                                    PREMIER NETWORKING EVENTS
           MixerPlease complete all four sections below to make your reservation
1.   Name:                                                                Company:             
     Phone        (             )          -                                 Email:            
           :
     Business                               
     Category:
     LBN Chapter:         
     Non-Members: Name of LBN Member who invited                                                
     you:
2.   Exhibitor:
                                                                       Exhibitor 4’ Table LBN or FON Member:                            $50.00
     -   Table top presentation space                                                               Non-Member:                         $75.00
     -   Table and cover                                               Exhibitor 8’ Table LBN or FON Member:                            $80.00
     -   4 hours of Networking                                                                      Non-Member:                        $105.00
     -   Continental breakfast for 1 person                                                     Electricity Needed:                      $0.00
     -   Electricity if ordered                                                                Offering Door Prize:                      $0.00
     -   Door Prizes                                         *Add $10 late fee if registering after February 9thth:                     $10.00
     - 4 hours of Networking
     Second Staff Member person
     - Continental breakfast for 1 at Exhibit:
                                            Name of Staff:                            2nd Staff Member at Exhibit:
                                                                                                                                       $15 each
     - Door Prizes                               Email:                                   

     Non-Exhibitor:                                      - 4 hours of              - Door Prizes         Non-Exhibitor:                $15 each
                                                         Networking
                                                         - Continental breakfast for 1 person

     Lunch & Networking:                                 - 12:15 pm – 2:00 pm           Total Lunch price ($20 per person):                     
                                                         - $20 per person  *If person attending lunch is different than or in addition to those
                                                                                           named above, please call 248-620-6320.


3.   PAYMENT                                        CHECK                     CREDIT CARD                         Total Amount:      
     OPTIONS
     CARD TYPE:          VISA              M/C                   DISCOVER          AMERICAN EXPRESS

     Name as it appears on card                
     Billing Address                                                                                                               
                                                STREET                                    CITY                        STATE      ZIP


     Card Number                            -                       -                 -                         Security Code:             
     Expiration Date:          /                Signature                                                       Date     

4.   To complete your reservation, do one of the following:
                       - Mail form with your check made out to LBN:                Local Business Network
                       - Sign up online at www.LocBusNet.com                       5446 Bristol Parke Dr.
                       - FAX form with payment info. to (248) 620-6321             Clarkston, MI 48348
                                       *All reservations must be received by February 11th.
                                     No cancellations after that date. No-shows will be billed
                                           FOR ADDITIONAL INFORMATION CALL (248) 620-6320

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Registration Form Winter 2011

  • 1. Club Venetian 29310 John R, Madison Heights, MI 48071 Thursday, February 17th LBN 8AM to Noon JOIN US FOR ONE OF Winter SOUTHEASTERN MICHIGAN’S PREMIER NETWORKING EVENTS MixerPlease complete all four sections below to make your reservation 1. Name:       Company:       Phone (     )     -      Email:       : Business       Category: LBN Chapter:       Non-Members: Name of LBN Member who invited       you: 2. Exhibitor: Exhibitor 4’ Table LBN or FON Member: $50.00 - Table top presentation space Non-Member: $75.00 - Table and cover Exhibitor 8’ Table LBN or FON Member: $80.00 - 4 hours of Networking Non-Member: $105.00 - Continental breakfast for 1 person Electricity Needed: $0.00 - Electricity if ordered Offering Door Prize: $0.00 - Door Prizes *Add $10 late fee if registering after February 9thth: $10.00 - 4 hours of Networking Second Staff Member person - Continental breakfast for 1 at Exhibit: Name of Staff: 2nd Staff Member at Exhibit:       $15 each - Door Prizes Email:       Non-Exhibitor: - 4 hours of - Door Prizes Non-Exhibitor: $15 each Networking - Continental breakfast for 1 person Lunch & Networking: - 12:15 pm – 2:00 pm Total Lunch price ($20 per person):       - $20 per person *If person attending lunch is different than or in addition to those named above, please call 248-620-6320. 3. PAYMENT CHECK CREDIT CARD Total Amount:       OPTIONS CARD TYPE: VISA M/C DISCOVER AMERICAN EXPRESS Name as it appears on card       Billing Address                      STREET CITY STATE ZIP Card Number       -       -       -       Security Code:      Expiration Date:    /     Signature      Date      4. To complete your reservation, do one of the following: - Mail form with your check made out to LBN: Local Business Network - Sign up online at www.LocBusNet.com 5446 Bristol Parke Dr. - FAX form with payment info. to (248) 620-6321 Clarkston, MI 48348 *All reservations must be received by February 11th. No cancellations after that date. No-shows will be billed FOR ADDITIONAL INFORMATION CALL (248) 620-6320