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Please fax your completed registration form to 609.345.8101. Payment is required in advance or at the event. Mail checks payable to ACHLA, 151 S. Pennsylvania Avenue, Suite 709, Atlantic City, NJ 08401
Name:_____________________________________________________________________
Company:__________________________________________________________________
Address:___________________________________________________________________
City: ______________________________State:__________________Zip:_____________
Phone: ___________________ Fax: ______________ Email:________________________
$40 PER TICKET # OF TICKETS______________TO PAY VIA CREDIT CARD CIRCLE ONE:
AMEX MASTERCARD VISA
Credit Card #____________________________________Exp. Date: __________________ |
NETWORKING LUNCHEON 
