Inland Valley Registration Form
3rd Annual Award Celebration HARLEM NIGHTS
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
How many will be participating?
*
I agree to {terms & conditions}.
*
Signature
*
My Products
*
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Members
$
25.00
Non Members
$
50.00
Donations
$
1.00
Support your Southern California Black Chamber of Commerce and make a donation today! Select your donation amount below.
Donation Amount
Total
$
0.00
Payment Methods
Debit or Credit Card
Please click one of the PayPal options to complete payment and
submit
the form.
Register
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