Registration Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" bgproperties="fixed" background="02c285a1erlcgo.png"> <div> <FONT SIZE="5" COLOR="#FFCC66" FACE="Arial" ><B>Christian Business Home Page CBE 06</B></FONT><B>  </B><B> </B><A HREF="index.htm" TARGET="_top" TITLE="Christian Business Home Page CBE 06"><U><B>Christian Business Home Page CBE 06</B></U></A><B>   </B></div> <div> <A HREF="id2.htm" TARGET="_top" TITLE="Local Business "><U>Local Business  </U></A>   |   <A HREF="id3.htm" TARGET="_top" TITLE="National Business "><U>National Business </U></A>   |   <A HREF="id4.htm" TARGET="_top" TITLE="International Business "><U>International Business </U></A>   |   <A HREF="media.htm" TARGET="_top" TITLE="Media "><U>Media  </U></A>   |   <A HREF="id16.htm" TARGET="_top" TITLE="Success Stories "><U>Success Stories  </U></A>   |   <A HREF="id17.htm" TARGET="_top" TITLE="Global Music "><U>Global Music   </U></A>   |   <A HREF="id18.htm" TARGET="_top" TITLE="China Business Seminar"><U>China Business Seminar</U></A>   |   <B>Registration  Form  </B>   |   <A HREF="id6.htm" TARGET="_top" TITLE="Contact Us"><U>Contact Us</U></A>   |   <A HREF="id20.htm" TARGET="_top" TITLE="Directions"><U>Directions</U></A>   |   <A HREF="id21.htm" TARGET="_top" TITLE="Classified"><U>Classified</U></A>   |   <A HREF="id23.htm" TARGET="_top" TITLE="Book Store"><U>Book Store</U></A>   |   <A HREF="id24.htm" TARGET="_top" TITLE="Group Discussion Forums"><U>Group Discussion Forums</U></A>   |   <A HREF="id25.htm" TARGET="_top" TITLE="Evaluation Form"><U>Evaluation Form</U></A>   |   <A HREF="id26.htm" TARGET="_top" TITLE="Shopping Center"><U>Shopping Center</U></A>   |   <A HREF="id27.htm" TARGET="_top" TITLE="l"><U>l</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFCC66" TEXT="#080000" background="02ad2c00dkelyh.png"> <div> <B><U>Exhibitor Packages</U></B></div> <div> <B><U>GOLD:                    </U></B><FONT SIZE="2" COLOR="#111111" FACE="Arial" ><B><U>   </U></B></FONT><B><U>     $300</U></B></div> <div> <B>Website Advertising (12 months ), Business Card AD in Directory, Table & Two Chairs </B></div> <bR> <div> <B><U>SMALL BUSINESS:         $250</U></B></div> <div> <B>Information in Directory, Table & Two Chairs</B></div> <bR> <div> <B><U>NEW BUSINESS:             $150</U></B></div> <div> <B>(For new businesses started in the past 12 months and with gross receipts of $25,000 </B><FONT SIZE="2" COLOR="#009900" FACE="Arial" ><B>& for non-profits, churches and ministries)</B></FONT></div> <div> <B>Business Information in CBE Directory, Table, Two </B><B>Chairs.</B></div> <div> <B><U>ADVERTISER PACKAGE:___$99</U></B></div> <div> <B>Business Card Ad in Directory and 12 months Website ad</B></div> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I><B><U>Registration  Form  </U></B></I></div> <div> <I><B>       </B></I><I><B><U><IMG SRC="21825150.gif" border=0 width="37" height="21" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></B></I><I><B><IMG SRC="21c25150.gif" border=0 width="37" height="21" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></I><I><B><U><IMG SRC="21925150.gif" border=0 width="37" height="21" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="21a25150.gif" border=0 width="37" height="21" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="21d25150.gif" border=0 width="37" height="21" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></B></I></div> <div> <B>       </B><FONT SIZE="3" COLOR="#CC9922" FACE="Arial" ><B>CHRISTIAN BUSINESS EXPO, 06</B></FONT><B>  </B></div> <div> <B>          Call 888-797-6484 or email to: </B><A HREF="business@cbepage.com" TARGET="_top" TITLE="business@cbepage.com"><U><B>business@cbepage.com</B></U></A></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B> <form action="http://csbmail.globalscape.com/cgi-bin/csbmail/csbmail.pl" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="Contact Person,Company Name,City,State,Zip,Phone and Fax Number,Email,Diamond Package,Gold Package,Silver Package,Advertising On:,Form Of Payment,Credit Card Number,Credit Card Verification Number (3 digits on the back of the Credit Card),Type of Credit Card,Name as it appears on Credit Card,Expiration Date,Amount of Payment,Billing Address,Comments"><input type="hidden" name="tlx_FormIndex" value="1"><input type="hidden" name="tlx_OKMessage" value="Thank you for filling out the Registration Form."><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="A comment form was submitted"><input type="hidden" name="tlx_EmailTo" value="business@cbepage.com"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">Contact Person:<br> <input type="text" name="Contact Person" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Company Name:<br> <input type="text" name="Company Name" size="30" maxlength="100"></td> </tr> <tr> <td align="left">City:<br> <input type="text" name="City" size="30" maxlength="100"></td> </tr> <tr> <td align="left">State:<br> <input type="text" name="State" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Zip:<br> <input type="text" name="Zip" size="10" maxlength="10"></td> </tr> <tr> <td align="left">Phone and Fax Number:<br> <input type="text" name="Phone and Fax Number" size="30" maxlength="110"></td> </tr> <tr> <td align="left">Email:<br> <input type="text" name="Email" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Diamond Package:<br> <input type="text" name="Diamond Package" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Gold Package:<br> <input type="text" name="Gold Package" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Silver Package:<br> <input type="text" name="Silver Package" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Advertising On::<br> <input type="text" name="Advertising On:" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Form of Payment:<br> <input type="text" name="Form Of Payment" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Credit Card Number:<br> <input type="text" name="Credit Card Number" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Credit Card Verification# ( 3 digits on the back of the credit card):<br> <input type="text" name="Credit Card Verification Number (3 digits on the back of the Credit Card)" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Type of Credit Card:<br> <input type="text" name="Type of Credit Card" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Name as it appears on Credit Card:<br> <input type="text" name="Name as it appears on Credit Card" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Expiration Date:<br> <input type="text" name="Expiration Date" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Amount of Payment:<br> <input type="text" name="Amount of Payment" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Billing Addres:<br> <input type="text" name="Billing Address" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Comments:<br> <textarea name="Comments" rows="5" cols="30"></textarea></td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Send" name="tlx_send"></td> </tr> </table> </form>  </B></div> <bR> <div> <B><U>ALL DEPOSITS AND PAYMENTS ARE NON-REFUNDABLE</U></B></div> <bR> <div> <B>Company Name:_________________________________</B></div> <div> <B>Phone:______________ Fax:_______________________</B></div> <div> <B>Contact Person:__________________________________</B></div> <div> <B>Address:________________________________________</B></div> <div> <B>City, State, Zip Code:______________________________</B></div> <div> <B>Email:__________________________________________</B></div> <bR> <bR> <bR> <div> <B>PLEASE CHECK ALL ITEMS YOU ARE PURCHASING</B></div> <bR> <div> <B>Exhibitor Package:</B><B> </B><B>Gold</B><B> </B><B>$300(__), </B><B>Small Business $250 (__),</B></div> <div> <B>New Business & Non-Profit $150 (__) Advertiser Package $80 (__)</B></div> <bR> <div> <B>Multiple Booth Discount: 20% Off  (__)</B></div> <div> <B>Electricity for Booth: $100 (__)</B></div> <bR> <div> <B>TITLE SPONSOR: $1,500 (__)</B></div> <div> <B>EVENT SPONSOR: $1,000 (__)</B></div> <bR> <bR> <bR> <bR> <bR> <div> <B>Total Amount Owed:</B><B>$_</B><B>___________</B></div> <bR> <div> <B>Payment Type: Check(__)   Money Order(__)    Credit Card(__)</B></div> <bR> <div> <B>Please Make Checks Payable to:  </B></div> <bR> <div> <B>      </B><B>    </B><FONT SIZE="3" COLOR="#3300FF" FACE="Arial" ><B>Christian Business Expo</B></FONT></div> <div> <B>          Attn: Jairo Sequeira</B></div> <div> <B>          574 Chaparro Road</B></div> <div> <B>          Covina, CA 91724</B></div> <bR> <div> <B>To Pay by Credit Card Please Complete and Sign the Following:</B></div> <DIV ALIGN="LEFT"></DIV> <div> <I><B><U><IMG SRC="21825150.gif" border=0 width="37" height="21" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></B></I><I><B><IMG SRC="21c25150.gif" border=0 width="37" height="21" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></I><I><B><U><IMG SRC="21925150.gif" border=0 width="37" height="21" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="21a25150.gif" border=0 width="37" height="21" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="21d25150.gif" border=0 width="37" height="21" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></B></I></div> <bR> <div> <B>Type of Credit Card (Visa or Mastercard):______________________ </B></div> <div> <B>Print Name as it appears on Card:____________________________</B></div> <div> <B>Credit Card #:_____________________________________________</B></div> <div> <B>3 Digit Verification # (as it appears on back of card):_____________</B></div> <div> <B>Expiration Date#:__________________________________________</B></div> <div> <B>Billing Address:___________________________________________</B></div> <div> <B>_________________________________________________________</B></div> <div> <B>Phone Number:___________________________________________</B></div> <div> <B>Signature of Card Holder:</B><B><U>X</U></B><B>_</B><B>_________________________________</B></div> <bR> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B><U>ALL DEPOSITS ARE NON-REFUNDABLE</U></B></div> <bR> <bR> </td> </tr></table></body>