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.
