Register for the Philanthropy Summit - Make A Difference Michiana

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Reserve Your Seat at the Philanthropy Summit

Tuesday, May 19, 2009 4:00-7:00PM @ The Waterford, SR 933 South Bend, IN

Please note that there are no issued tickets to the event. Your name will be on a list at the door.

Purchasing a table entitles you to signage and inclusion of your business/group in the Still Making a Difference slideshow. We'll contact you to get information on how your group makes a difference so that we can add it to the community-wide composite of stories.

Non-profits: If you're interested in being part of the Non-Profit Expo, please contact us.

Questions? Contact us.

REGISTRATION FORM
	I'd like to purchase a table of 8 and have my business/group included in the *Still Making a Difference* project. ($320)
	I'd like to purchase individual tickets at $30 each.
	I cannot attend, but I'd like to donate to Make a Difference Michiana.

GRAND TOTAL

Grand Total:

YOUR INFORMATION
Name:	*
Company Name:	*
Address:	*
City:	*
ST:	*
Zip:	*
Phone:	*
Email:	*
	* - required field
Please list the names of others in your party, OR names of those with whom you'd like to be seated:

PAYMENT OPTIONS
Please to pay on-line. You will be directed to our secure partner site, Paypal, to pay by check or credit card. If you would prefer not to take advantage of our on-line payment option, please to submit your information via email and mail your payment to: Make a Difference Michiana, Inc. P. O. Box 4073 South Bend, IN 46634 Phone: (574)232-3660 ext. 214

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Reserve Your Seat at the Philanthropy Summit

REGISTRATION FORM

GRAND TOTAL

YOUR INFORMATION

PAYMENT OPTIONS