Name: Name Tag:

Company/Organization:

Family Members and/or Associates to Attend:

1) Name: Name Tag:

2) Name: Name Tag:

Address:

City: State: ZIP Code:

Office Phone: E-Mail:

Mobile Number: Fax Number:

Web Site:

Check the boxes below if you or your family members require a vegetarian lunch:

Self Family Member/Associate #1 Family Member/Associate #2

Contact:
If you have any questions regarding this seminar, please contact the Center for Entrepreneurship by telephone at (910) 630-7642 or by e-mail at

Payment Information:
You will receive a receipt of what you have submitted when you click "Submit Registration" below. This is not a confirmation of conference registration. You will be contacted by the Center to make payment arrangements.

Tax Deduction of Expenses:
An income tax deduction is allowed for expenses of education (including registration fees and travel) undertaken to improve professional skills. (Reg. 1.1162-5)