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Program Listing Order Form


Program Listing Order Form

*= Required
Contact Name*
Contact Organization
Contact Address*
Contact City*
Contact State*
Contact Zip Code*
Contact Business Phone*

(required for receipt)

Title of Event*
Date of Event*
Location of Event*
Cost of Event*
Sponsor of Event
Web Site Link of Event

(Select Only One)
$40 - Cascadia Chapter Member
[Chapter Member Number:  ]
$60 - Non-Profit Organizations and Affiliates
$75 - For-Profits and Non-Members

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