ITC Annual Dinner
Primo South Banquet & Conference Center
Thursday, November 10, 2011
Networking Hour - 6 - 7 pm
Dinner to Follow
Billing Information:
Company Name
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Billing Contact First Name
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Billing Contact Last Name
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Billing Address 1
Billing Address 2
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City
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State
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Postal Code
Phone
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Email Address
Ticket Prices
Member & their guests/IMTA Member $30
Past Presidents & Retirees $20
Non Member & their guests $35
Please select membership status:
I am a member of ITC or the IMTA
I am a Past President or Retiree
I am not a member ITC
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How many people are attending?
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How many people are attending?
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How many people are attending?
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2
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Please indicate everyone you are signing up for this event.
Company Name
First Name
Last Name
Phone Number
Email Address
Company Name
First Name
Last Name
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Company Name
First Name
Last Name
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Email Address
Company Name
First Name
Last Name
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Company Name
First Name
Last Name
Phone Number
Email Address
Be a Bar Sponsor for $100.00
Would you like to help sponsor this event being a bar sponsor for $100?
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- Please choose -
Yes
No, thank you
Scholarship Donation Opportunity
Would you like to donate money to the Indianapolis Traffic Club Scholarship Fund? Any amount will help.
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--Please select Yes or No --
Yes, I will donate money to the ITC Scholarship Fund
No, I will not donate at this time.
Please enter dollar amount you wish to donate. Your scholarship donation is greatly appreciated and you will be recognized for your generosity in the next monthly publication and also on our website.
Payment Information
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How will you be paying for this event?
I will pay by Credit Card
I will pay by Check
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Indicates Response Required