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Gala Tickets

To purchase tickets, please fill out the form below and click 'submit gala registration' or print out the registration form and send with payment to:
Technology Council of Central Pennsylvania
3721 TecPort Drive
Suite 150
Harrisburg, PA 17111

Please complete and return with payment by March 1, 2006

General Information
Company Name:
Address:
Address:
City:
State:
Zipcode:
Main contact name:
Main contact phone:
Main contact fax:
Main contact email:
Is your company a current Member of TCCP? Yes No

Quantity
Description
Price Each
Extended
Individual Attendance - member$150
5 attendees - member$500
Corporate Sponsor - member$2,000
Individual attendance - non-member$200
Amount Due:
Date Due, No Refunds:March 1, 2006

Attendees to be registered:
Name (to be used on nametag)Company NameEmail


Method of Payment
Total ticket amount:
$
Please call me to complete ticket purchase
Check should be mailed and be made payable to:

Technology Council of Central Pennsylvania
3721 TecPort Drive
Suite 150
Harrisburg, PA 17111
Wachovia