2010 N.C. STATEWIDE MUSLIM BUSINESS CONFERENCE

REGISTRATION/PARTICIPATION FORM

NAME:_________________________________

ADDRESS:______________________________

TELEPHONE:____________________

E-MAIL:_________________________

*Check Wherever Applicable

REGISTRATION: (Sat: Workshops/Lunch)-$20 (Individual)

TICKETS: (Fri: Social Night)-$10 (Individual)

(Sat: Dinner/Fashion Show)-$20 (Individual) $35 (Couple)

(Sun: Brunch)-$10 (Individual)

VENDING: (Fri.-Sun.)-$50

BUSINESS SPONSOR AD: -$25 (Quarter Page) -$50 (Half-Page) -$100 (Full-Page) -More (List Amount Paid)

Amount Paid:______

BUSINESS CONFERENCE DONATION: (List Amount)

Amount Paid:______

*Registration/Participation Due: Oct. 24, 2010

Pay To: Al Ummil Ummat Islamic Center

Mailing Address: P.O. Box 36288, Zip Code: 27416

E-mail Address: alummil_ummat@yahoo.com

Website Address: http://www.alummil-ummat.org

Telephone Number: (336)-574-3689