Univera Super Saturday April 18, 2009

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EVENT SCHEDULE:
Saturday April 18, 10:00AM (Central) - 4:00PM (Central)
TICKETS:
EARLY BIRD TICKETS: ________ AT $25 EACH = ________
AT THE DOOR TICKET(CASH ONLY):________AT $40 EACH =________
NAME (FOR BADGES):
_________________________________________________________________________________________________
_________________________________________________________________________________________________
CREDIT CARD INFORMATION:

NAME (AS IT APPEARS ON THECARD): ____________________________________________________________

BILLING ADDRESS: ____________________________________________________________
____________________________________________________________
STATE _____ ZIP CODE ___________

PHONE _____________________________________________________
EMAIL(PLEASE PRINT CLEARLY): ______________________________________________

CARD TYPE(CIRCLE): VISA / MC / DISC / AMEX
CREDIT / DEBIT CARD NUMBER: _____________________________________________
EXP DATE: _____ / _____ CID(3 DIGIT NUMBER ON BACK OF CARD): _____

I understand that I will receive an email with my ticket confirmation when the payment has been processed. This email will serve as a receipt for my tickets and needs to be shown at registration to receive my name badge(s)

SIGNED ______________________________________________________ DATE ____ / _____ / _________


Organized by UNIVERA LEADERSHIP TEAM
Call Patty Middleton with any questions about the event at 574-532-5657.
To use this interactive online form as a hard copy sign up sheet, please print and have the individual fill out the required information.
As their sponsor, it is your responsibility to enter their order online at www.univera.eventbrite.com. A confirmation will appear (please print) and an email will be sent to the purchaser. they will need to print the email and take it to the event.

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Ticket Info:  

• Early Bird Ticket, $25.00
• Door tickets ($40 Cash) only after 04/15/09, $40.00

Official Website: http://univera-upcoming.eventbrite.com