CAI-NJ Jan.2018 (w)

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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._________________________________________________________________
Payment options:
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 .
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: or call:
(609)588-0030
Registration Form
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!