Electric Association Women's Division

	Online Registration for Women's Division Events Women's Division Holiday Party 4:30pm - 7:30pm, Thursday, November 21 at the Sugar Factory in Rosemont

Full Name
Company
Company Street Address
Company City, State, ZIP
Phone
Fax
Email Address

	Member Registration Rate: $85
Total Amount:
	You can print this form and mail it with a check to the Electric Association:17W733 Butterfield Road, Suite B, Oakbrook Terrace, IL 60181 (or) Visa, MasterCard, and American Express are accepted below. You can also print this form, scan and email to: akasser@eachicago.org Cancellations after November 15 will not be given a refund.
Method of Payment	(a 5% convenience charge will be added to all credit card payments)
Credit Card Number
CC Exp. Date
Cardholder name
	Credit card billing address is the same as company address above If credit card billing address is different from company address, please specify below:
CC Billing Street Address
CC Billing City, State, ZIP
	Cancellation policy: Refunds will not be guaranteed after November 15, 2019.