ACIT Advancement for Commerce Industry and Technology

Event Registration

Company Name:

Member Name (s):
(separate names
with a line break)

Date Of The Event
you are attending

Phone:

Fax:

E-Mail Address:

Web Site:

Address:

Suite:

City:

State:

Zip:

Payment Options

Check - Please Bill Me (invoice)
Pay by Phone

Charge

Credit Card Number:

Expiration Date:

Name on Card:

ACIT · P.O. Box 151, Farmingdale, NY 11735 · Ph: 631.789.1660 · Fax: 631.789.4514 · email: info@acit.com