AFP Program Registration #2

Full Name *

First Name Last Name
AFP Member? *

Yes No
Phone Number *

Area Code Phone Number
Company:

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *
Date of AFP Program *
Additional names and email addresses of those attending:
Do you want to be invoiced?

Yes No
Or to Pay at this time:

Please make checks payable to:
AFP Mahoning-Shenango Chapter

Mail check to:
AFP Mahoning-Shenango Chapter
PO Box 672
Youngstown, OH 44501

OR

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