Jan 2018

The Imperia: 1714 Easton Ave, Somerset, NJ 08873 Registration/Cocktail Hour: 6:00pm-7:00pm Dinner & Awards: 7:00pm-10:00pm Be Sure to Wear Your MADDEST Hat!

Registration Form

Payment options:

Name/Designation: _________________________________________________ Company:__________________________________________________________ Address:___________________________________________________________ City, State, Zip: _____________________________________________________ Phone: ____________________________________________________________ Fax: _______________________________________________________________ Email: _____________________________________________________________ Note: Ultimate partners receive 4 tickets, Elite partners receive 2 tickets and Premier partners receive 1 ticket. _______ # of partnership tickets _______$130/ person OR _______ $1,200/ table (10 guests per table) Please list the name, company and designations of additional registrations. 2. _________________________________________________________________ 3. _________________________________________________________________ 4. _________________________________________________________________ 5.__________________________________________________________________ 6.__________________________________________________________________ 7.__________________________________________________________________ 8. _________________________________________________________________ 9.__________________________________________________________________ 10._________________________________________________________________

Make check payable to CAI-NJ Mail completed form and payment to: CAI-NJ, 500 Harding Road, Freehold, NJ 07728

Pay by credit card: Please fax to (609) 588-0040 or email to jaclyn@cainj.org. Cardholder Name: __________________________________________ (as it appears on the card) Card Number: ______________________________________________ Exp. Date: __________ Security Code: __________________________ Cardholder Signature: _______________________________________ Cardholder acknowledges receipt of goods and/or services in the amount of the total shown here and agrees to perform the obligations set forth in the cardholder’s agreement with issuer.

TOTAL $____________________

*Cancellation Policy-Cancellations must be made by February 8, 2018 in order to receive a refund. Swaps can be made at any time. For more information: email: Jaclyn@cainj.org or call: (609)588-0030