Underfashion Club Holiday Party: December, 9th 2010

December 9, 2010
HOLIDAY PARTY

Event Registration

FAX (845-758-2546) or EMAIL (underfashionclub@frontiernet.net) this form to register. Make checks payable and mail to Underfashion Club, 326 Field Road, Clinton Corners, NY 12514. If you have any questions, contact the club office by phone at 845-758-6405 or email us at underfashionclub@frontiernet.net.


PLEASE RESERVE:

______________Attendee(s) @ $50 PREPAID =

______________Attendee(s) @ $60 Paid at the door =


Contact Name _____________________

Firm _____________________

Street Address ______________________

City _____________
State_________ Zip__________

Telephone _____________________
Fax ________________________

Email _______________________


TO PAY BY CREDIT CARD: Enter ALL of the information requested below

AMEX MasterCard VISA Discover

Cardholder’s Name
(Exactly as it appears on the card)___________________

Account Number _______________________

Expiration Date ________
**Security Code _______

Billing Address ______________

City ______________
State______ Zip_____________

Billing Telephone Number ____________________________

** For MasterCard, VISA and Discover, the security code (usually 3 digits) is located on the back of the card in the signature panel after the last 4 digits of the card number. For AMEX, the 4-digit security code is located on the front of the card, right above the account number.