Economic Super Panel February 8, 2012 Registration

Location: Crowne Plaza King Harbor – 300 N. Harbor Dr., Redondo Beach
Cost: $15 per person
Time: 8:00 a.m. – 10:00 a.m.
Parking: $6.00 self parking / $9.00 valet
RSVP: Registration and payment due by January 31, 2012
attendee Names:
  First name Last name
First Attendee ($15)*:
Second Attendee ($15):
  Agent's name if working with South Bay Broker's Agent:
Select Agent Name:
Email for confirmation*:
     
Billing Information:
Street*:
Apartment No:
 
City*:
State*:
Zip Code*:
  
Credit Card Type*:  
   
Cardholder Name*:
Credit Card Number*:
 
CVC2 Code*:
(last 3 digits back of card)
Expiration Date*:
 
*:Enter Text Shown in Picture
* Denotes Required Field