AFCEA Member Status?	Member of AFCEA NonMember
Membership Number
Prefix/Rank
First Name
Last Name
Title/Position
Company/Service/Org
Company Size	1-25 employees 26-150 employees 151-500 employees 501 or more
Email
Tel
Fax
Address Street
Address City
Address State
Address Zip
Special Needs
Registration Rate	_____________________________________________ Industry Individual Member - $30 Industry Individual Non-member - $35 Government - No Charge     (Please select "Government - No Charge"      under Payment Method Below!)
Would You Like to be Contacted About Becoming A Corporate Table Holder?	_____________________________________________ Yes, Please contact me about sponsorship opportunities. No thanks, not at this time. _____________________________________________
COMMENTS Example: How did you hear about the AFCEA NOVA Small Business Breakfast?
PAYMENT
Payment Method	Please Select One (And Did you Push to Total Above?) Credit Card - Be Sure You Pushed the Total Button Above Check - Be Sure You Pushed the Total Button Above Government Employee - No Charge Volunteer - No Charge Industry Table Holder - No Charge Press - No Charge Speaker or His/Her Staff Aid - No Charge Guest - No Charge with prior approval
All Check Payments Should Be Mailed To: AFCEA NOVA Events c/o Capital Leadership Group 428 Hume Ave., 2nd floor Alexandria, VA 22301 tel: 703-997-3006 Deadline for cancellations or refunds: 48 hours prior to the event. No refunds thereafter. Form created by: Capital Leadership Group Where the Public, Private, and Civic Sectors Converge. Copyright © 2006 [Capital Leadership Group] All rights reserved.