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Online Registration for Young Electrical Professionals

Fall Panel Discussion Event: Professonal Development in the Electrical Industry

Location:  Taste 222, 222 North Canal Street, Chicago, IL 60606

Tuesday, November 5- 4:30pm to 7:30pm

Hors d' oeuvres and drinks will begin at 4:30 pm with Panel Discusssion Program to begin at 5:30 pm.

Full Name
Company
Company Street Address
Company City, State, ZIP
Phone
Fax
Email Address
   
How did you hear
about this event?
  Have you attended a Young Electrical Professionals Event in the past?
     
Additional Attendee Name:
Company:

Additional Attendee Name:
Company:

 

$75 per person for event entrance

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.

Refunds will not be given for this event with less than a 72 hour cancellation.

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