Jingle and Mingle Registration

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Attendee Information

Name *

First

Last

Employer *

Job or Association Title

Phone *

Email *

Registration Information

How many in your party?

Selected Value: 1

Number of people you are registering, including yourself.

Are you a DAHCC Member? *Choose OneYesNo

Select how many attendees you are registering. First attendee from organization is free. Additional attendees and ALL non-members are $50 each.First Member is FreeOne Member (free) – $ 0.00Two Attendees – $ 50.00Three Attendees – $ 100.00Four Attendees – $ 150.00Five Attendees – $ 200.00

Select how many attendees you are registering. First attendee from a member organization is free. Additional attendees and ALL NON-MEMBERS are $50 each.Each Member is $50One Attendee – $ 50.00Two Attendees – $ 100.00Three Attendees – $ 150.00Four Attendees – $ 200.00Five Attendees – $ 250.00Testing Amount – $ 1.00

Attendee Names

Name of First Attendee

Name of Second Attendee

Name of Third Attendee

Name of Fourth Attendee

Name of Fifth Attendee

Payment Section

Total Payment Due

$ 0.00

Credit Card *

Card

Name on Card

Add any additional comments (or questions) below about your attendees.

Other Comments or questions

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