Name(s): Company: Address: Phone: Fax: E-mail: # of Reservations: Total Payment Amount: $ Credit Card Payment: (All information must be provided in order to process payment)Visa/MC/Discover/Amex # (circle one): Exp. Date: Customer Verifi cation Number: (3-Digit for Visa/MC/Disc or 4-Digit for Amex)Billing Address: City State Zip: ***Registration for this event must be paid in advance. All cancellations must be received four (4) days prior to the event for a full refund. Limited number of seats available. Registration assigned on a “First paid, fi rst registered basis.”

Women’s Council Networking LuncheonPROVIDING QUALITY INFORMATION & INSPIRATION FOR WOMEN IN THE WORKPLACE

To register for “Women’s Council Luncheon 4/21/11,” please make checks payable to: Greater Elkhart Chamber of Commerce, P.O. Box 428, Elkhart, IN 46515 -OR-

REGISTER ONLINE at www.elkhart.org -OR- make a copy of this form and fax with credit card information to: (574) 294-1859

Chamber Members: $15 per person • Non-Members: $25 per personReservations must be placed in advance - Limited seating

Register online at www.elkhart.org, check made payable to the Greater Elkhart Chamber of Commerceor credit card is required to hold reservation. Registration deadline is April 18.

Becoming anEntrepreneurial Diva:Empowering the Entrepreneur Inside, Personally and Professionally

April 2111:30 am - 1:00 pm

Christiana Creek Country Club,116 W. Bristol St., Elkhart

Staci Lugar Brettin