Pat Dolen

Registration

Texas Women Who Rock Event

(September 25th, 2009)

You get IT ALL – Relevant Information – Fabulous Fun-Powerful Connections
and a scrumptious breakfast!

Friday, September 25, 2009
8:00 a.m. to 11:30 a.m.
Doors open at 7:45 a.m.
Breakfast & Networking 8:00 to 8:30 a.m.
Program starts at 8:45 a.m.

$79.00 Early Bird Registration before or on Wednesday, September 23rd, 2009

$89.00 If registered after September 23rd, 2009

$99.00 At the door (If space available)

Enter the appropriate amount:

Payment Amount (required)

Name on Credit/Debit Card (required)

Address on file of Credit/Debit Card (required)

City/State/Zip on file of Credit/Debit Card (required)

Email Address (required)

Phone Number (required)

How did you hear about us?

Card Type

Card Number (required)

Select Card Exp Month
Select Card Exp Year

CVV2 Code (required)

NOTE: The CVV2 code will be the last 3 digits within signature line on the back of your credit card. If Amex, then 4 digits on the front of card above the card number.

NOTE: By clicking ‘Send Registration’, you are agreeing to pay the registration fee. Call Pat Dolen at 713-838-8787 with any questions on this registration/payment.

Thank you for registering.

To ensure your registration has been properly recorded, please scroll to the top of this page now and look for “Your message was sent successfully. Thanks.” This is automatically generated upon clicking the “Send Registration” button and indicates your payment will be processed within 24 to 48 hours. If you did not see this message after scrolling to the top of the page, then please call 713.838.8787 or email pat@tydemandolen.com to confirm that your registration has been received.