Fill and Sign the T2201 E Form

Kansas City Small Business Networking Breakfast REGISTRATION FORM 7:30 a.m. – 8:45 a.m. monthly, doors open at 7:15 a.m. The Kauffman Conference Center • 4801 Rockhill Road • Kansas City, MO 64110 The registration fee is $18.00 and is due by noon on the Friday preceding the breakfast. NO registrations will be accepted after noon on the preceding Friday.** Faxed reservations are accepted only if they contain COMPLETE billing information. Registration constitutes a final commitment for the meeting and fees will not be reimbursed or applied to a future registration. If you are unable to attend, an alternate representative from your company/organization will be welcome. NO registrations will be accepted by phone. Arrangements for individuals with special needs must be made in writing and faxed to 816-823-5104. Check/Money order. Made payable to the Federal Executive Board. A copy of the check must be included with the faxed registration, and original check mailed to the FEB. All returned checks will be subject to a $30.00 service fee to be paid by money order or cashier check. Charge my Credit Card: Credit Card Number: ___________ □ Visa □ MasterCard ____________________ Expiration Date: ________ _ Please print clearly. Credit cards will be processed approximately one week prior to the breakfast. ___________________ Signature: _____ Card Holder’s Phone Number: Name of Attendees Please print clearly or type your name as you wish it to appear on nametag. Name: _______ __________ ________________ Additional Attendees: _______ _______ __________ Organization: _______ Address: _______ _______________ __________ City: State: Fax: ______ Email: ___________ Zip: ______________ Phone: ____ Website: _________________________ ___ □ Check here if you would like your business information publicly available on a government Web site as a registered attendee so that you may continue to network with your fellow attendees. □ Check here if you plan to attend the after-breakfast workshop, if one is scheduled. SEND CHECK AND COMPLETED REGISTRATION FORM(S) BY MAIL OR FAX TO: FEDERAL EXECUTIVE BOARD 1500 E. Bannister Road, Ste. 1176 Kansas City, MO 64131 FAX: 816-823-5104 – Questions: 816-926-7203     IMPORTANT REMINDERS If pre-paying by check, fax a copy of the check and completed registration form, then mail the originals immediately. **Those missing the registration deadline may attend as a walk-in and will be accepted only up to the meeting room’s 200 person capacity. The fee is $20.00 payable by Cash or Check ONLY – NO CREDIT CARDS will be accepted at the door. Please bring your business cards for the monthly drawing and for networking purposes. Door prizes are welcomed and acknowledged.