EcONOmic & cArEEr SummiT - US Black Chamber, Inc.
EcONOmic & cArEEr SummiT - US Black Chamber, Inc.
EcONOmic & cArEEr SummiT - US Black Chamber, Inc.
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You’re Invited....<br />
On behalf of the U.S. <strong>Black</strong> <strong>Chamber</strong>, <strong>Inc</strong>. (<strong>US</strong>BC), and our Western Regional headquarters, we invite you to<br />
join us for the first ever Solution Series Event. As part of the Greater Phoenix <strong>Black</strong> <strong>Chamber</strong> of Commerce<br />
(GPBCC) Annual Economic & Career Summit, this promises to be an exciting and highly enlightening professional<br />
development conference for small business owners and corporate professionals alike.<br />
The GPBCC Economic Summit is a premier educational event, and your vehicle for building the skills needed to<br />
successfully manage and grow your small business, secure a new job, access the tools necessary as you travel<br />
on your pathway to success. Now in conjunction with the <strong>US</strong>BC, this regional event is shaping up to be truly<br />
valuable, and is one that brings together the best of small business owners, chamber leadership, corporate<br />
partners and policy makers all the way from Washington D.C. to the Western United States, all in one place,<br />
and at one time!<br />
This two-day event will provide you with unprecedented educational and networking opportunities, including<br />
a host of dynamic speakers at plenary sessions and workshops. Information will be shared on successful approaches<br />
and strategies empowering your business to make national connections. Thanks to the commitment<br />
of our over100 African American chambers, programs and opportunities like this have been able to reach many<br />
more small minority businesses across the country.<br />
We hope that you, along with colleagues, will join us to be one of more than 400 corporate executives, government<br />
officials, chamber leaders, and business owners who will attend one of our biggest events of the year.<br />
Please share this opportunity with others in your organization that could benefit from attending the premier<br />
forum on minority business and economic development. Make the most of what this entire event has to offer.<br />
Finalize your plans and send in your registration form today!<br />
On behalf of our both of our Board of Directors and Professional Development Committees, we thank you for<br />
your continued support and look forward to seeing you in Phoenix, AZ.<br />
In the Spirit of Success,<br />
Ron Busby Kerwin Brown<br />
President & CEO Chairman & CEO<br />
U.S. <strong>Black</strong> <strong>Chamber</strong>, <strong>Inc</strong>. The Greater Phoenix<br />
<strong>Black</strong> <strong>Chamber</strong> of Commerce
About the Summit<br />
The U.S. <strong>Black</strong> <strong>Chamber</strong>’s “Solution Series” promotes the<br />
connection of national, regional and local resources in our efforts to<br />
advocate for small business & economic development in minority<br />
communities. The intent is to increase awareness of our national<br />
footprint by focusing on the growth, efficiency, and influence of our<br />
agenda through education, training and the sharing of industry best<br />
practices.<br />
Through plenary sessions, workshops, webinars, and networking<br />
opportunities, our members and participants will walk away with the<br />
tools necessary to tackle the obstacles they face on their pathway to<br />
success.<br />
“A regional event...<br />
with national exposure”<br />
We pride ourselves on our diverse faculty, recruited from all over the<br />
United States. The line-up consists of a variety of seasoned<br />
governemnt officials, corporate executives, consultants, practitioners,<br />
and academics. These individuals bring a broad range of experience<br />
and knowledge to our Economic & Career Summit.<br />
This is a two day summit that focuses on:<br />
· Educating small business owners on how to become business<br />
ready<br />
· Training corporate employees on how to leverage one’s skills to<br />
climb the corporate ladder<br />
· Developing mentorships with those under and over 40 in<br />
preparation to pass the torch<br />
· Informing everyone about the latest public policy issues facing<br />
small business owners<br />
· Presenting innovative business solutions to help your business or<br />
organziaton operate more effectivly and efficiently<br />
· Leverage new contract opportunities for your business to take<br />
advantage of<br />
· Career placement and one-on-one coaching to help connect those<br />
organizations seeking to diversify their workforce.<br />
Who should attend the<br />
Summit?<br />
This event is designed for those with a<br />
strong interest in growing their organizations<br />
and professionals looking to advance<br />
their careers.<br />
The curriculum offers a broad range of<br />
courses, from how to start a small business<br />
to underutilized national programs<br />
on acces to capital.<br />
Specifically, this event is the ideal source<br />
of professional development and training<br />
for individuals on the following career<br />
paths:<br />
- Entry level positions<br />
- The “C-Suite” and Executive Staff<br />
- Board Members<br />
- Administrative Officers<br />
- Human Resource Managers<br />
- Finance Managers/Directors<br />
- Program Managers/Directors<br />
- Technology Officers/Managers<br />
- Marketing Managers/Directors<br />
- Development Officers/Managers<br />
- Communications Officers/Managers<br />
Sample Summit Agena<br />
DAY ONE<br />
8:00 am On-site Registration<br />
8:30 am Welcome from the President<br />
9:00 am Morning Motivation<br />
9:30 am Classes<br />
12:00 noon Luncheon & Expo<br />
2:30 pm Classes<br />
5:30 pm Reception<br />
DAY TWO<br />
8:00 am Expo & Job Fair featuring:<br />
career placement; resume<br />
proofing; mock interviews;<br />
Raffles; <strong>Black</strong> <strong>Chamber</strong> Live<br />
TV; “Mob our Members”<br />
continuing education, life<br />
coaching & professional<br />
headshots; and a “high noon<br />
fashion show”<br />
5:00 pm Expo Closes<br />
6:00 pm Live Concert & Reception
About the U.S. <strong>Black</strong> <strong>Chamber</strong>, <strong>Inc</strong>.<br />
MISSION STATEMENT<br />
The U.S. <strong>Black</strong> <strong>Chamber</strong>, <strong>Inc</strong>. (<strong>US</strong>BC) provides committed, visionary leadership and<br />
advocacy in the realization of economic empowerment. Through the creation of resources<br />
and initiatives, we support African American <strong>Chamber</strong>s of Commerce and business<br />
organizations in their work of developing and growing <strong>Black</strong> enterprises.<br />
VISION STATEMENT<br />
<strong>US</strong>BC is an association of over 100 self-sustaining, viable <strong>Black</strong> <strong>Chamber</strong>s and small<br />
business associations nationwide whose collaboration with strategic partners increases<br />
our capacity to serve.<br />
VALUE PROPOSITION<br />
We strive for excellence in our organizational operations by focusing on integrity,<br />
credibility, and adding value to our clients.<br />
About the Greater Phoenix <strong>Black</strong> <strong>Chamber</strong><br />
MISSION STATEMENT<br />
The mission of the Greater Phoenix <strong>Black</strong> <strong>Chamber</strong> of Commerce (GPBCC) is to improve the economic<br />
development of our business entrepreneurs and the communities we serve. The GPBCC serves as the cornerstone<br />
for educational training, resource programs, resources and economic growth opportunities with a<br />
specific emphasis on “Business In Action”.<br />
We exist to facilitate the economic empowerment of the Greater Phoenix <strong>Black</strong> community and our<br />
<strong>Chamber</strong> members through the promotion of entrepreneurship on a variety of levels, including but not<br />
limited to:<br />
• Offering leadership and advocacy in efforts regarding economic, political and social issues<br />
• Facilitating relationships between <strong>Chamber</strong> members, existing <strong>Black</strong>-owned businesses; and the<br />
Greater Phoenix corporate community<br />
• Attracting local, national, and international business opportunities for <strong>Black</strong>-owned enterprises<br />
• Educating our membership in the most current productive and efficient business practices<br />
• Assisting whenever possible in the cultivation of fledging <strong>Black</strong>-owned enterprises<br />
• Acting as a clearinghouse for information, opportunity and dialoge
ADVOCACY<br />
The <strong>US</strong>BC fights for legislation that<br />
promotes small business growth,<br />
particularly policies that address the<br />
challenges of <strong>Black</strong> business owners.<br />
We understand the importance of<br />
maintaining a bipartisan approach to<br />
advocacy, and hence, collaborate with<br />
policy makers from all political affiliations<br />
to advocate for policies that best<br />
serve the interest of the <strong>Black</strong> community.<br />
ACCESS TO CAPITAL<br />
Capital access remains the most important<br />
factor limiting the establishment,<br />
expansion and growth of <strong>Black</strong>owned<br />
businesses. The <strong>US</strong>BC works<br />
with financial institutions, particularly<br />
<strong>Black</strong>-owned institutions, to create avenues<br />
by which <strong>Black</strong> businesses can<br />
gain greater access to credit, capital<br />
and other financial instruments.<br />
CONTRACTING<br />
At the <strong>US</strong>BC, our goal is to level the<br />
playing field by helping members gain<br />
access to business opportunities in<br />
private and public sectors. We accomplish<br />
this by educating members<br />
on contract opportunities, helping<br />
them increase their capacity to bid for<br />
large scale contracts, and offering resources<br />
and information that enhance<br />
<strong>Black</strong> owners’ ability to compete.<br />
ENTREPRENEUR TRAINING<br />
The <strong>US</strong>BC is committed to helping<br />
<strong>Black</strong> business leaders achieve stellar<br />
performance and growth through entrepreneur<br />
and business management<br />
Our National Footprint<br />
The infrastructure of the <strong>US</strong>BC allows for a quick mobilization of messaging and support in all 50 states. National policy<br />
positions are finalized in our Washington, DC headquarters, and then filtered throughout the country by five Regional Directors<br />
that ensure and support the delivery of messaging to our 100+ <strong>Black</strong> <strong>Chamber</strong>s and Business Associations. Our mobilization includes<br />
highly targeted communications from chamber leaders to local business, community leaders, elected officials and policy staff.<br />
We take pride in our ability to influence policy by generating letters of support, calls, and face-to-face meetings with key<br />
decision makers at the local, state, and federal levels as it relates to <strong>Black</strong> and small businesses.<br />
[ Five Pillars of Service ]<br />
The <strong>US</strong>BC’s Five Pillars of Service are the cornerstone of our platform. They represent issues that greatly impact the<br />
growth of <strong>Black</strong>-owned businesses in America and consequently, form the foundation of the <strong>US</strong>BC’s agenda.<br />
training. Hence, we deliver quality<br />
educational opportunities and professional<br />
development resources that<br />
help our members manage and grow<br />
successful businesses.<br />
B<strong>US</strong>INESS DEVELOPMENT<br />
The growth and development of <strong>Black</strong><br />
chamber members, businesses and individuals<br />
is a core focus of the Greater<br />
Phoenix <strong>Black</strong> <strong>Chamber</strong> of Commerce.<br />
As such, we leverage our role as a regional<br />
organization, provide technical<br />
assistance and leadership training to<br />
members, and facilitate the sharing<br />
of best practices and industry data<br />
among our members. To do this, we<br />
utilize a variety of mechanisms including,<br />
training, web-based tools, peer<br />
networking, coaching, and information<br />
products.
[ PhoEnIx, AZ ]<br />
<strong>EcONOmic</strong> & <strong>cArEEr</strong> <strong>SummiT</strong><br />
MAking CoAST To CoAST ConneCTionS<br />
A · G · E · N · D · A<br />
Thursday | 11.8.12<br />
8:45am WArm uP AND mOTiVATiON EXErciSE | The Generative<br />
Action Process That Takes A Dream To Reality<br />
FEATURING: Dr. Joel martin, Positively Powerful Women<br />
9:30am uSBc POWEr PANEL | Access to Capital. Small business owners need capital to<br />
fuel their product launch, add new business lines, and expand into new markets. This panel<br />
will show case presenters from all across the country who represent a wide range of financing<br />
programs, that will provide you with the fuel you need to grow your enterprise!<br />
11:15am Morning Break<br />
11:30am BrEAKOuT SESSiONS<br />
ENTrEPrENEur TrAiNiNg | GPBCC Entrepreneurial Training Program<br />
BuSiNESS DEVELOPmENT | Organizational vs Personal Branding. Learn to<br />
master the business of YoU! What impression do people walk away with when they interact<br />
with your brand online? How does your reputation stack up? Are you perceived the way you<br />
would like to be perceived? What compelling reason do you give people to choose brand YoU?<br />
For organizations, the message is no different! Your employees are your most organic channel<br />
of marketing, educating them in the art of Personal Branding can unleash results impossible<br />
through traditional media.<br />
FEATURING: robert Van Arlen, Speaker, Author, Coach<br />
YOuNg ENTrEPrENEurS | The 1, 2, 3’s of Starting A Business. Before you<br />
make the decision on whether or not you should take the plunge and go into business for<br />
yourself, there are a number of very basic questions that you should have first considered<br />
very thoroughly, which may help you to decide whether or not you are ready to start a particular<br />
business. This introductory session is designed to alert you to a number of key points<br />
you may not have considered yet, as well as assist you in dealing successfully with some of<br />
the initial problems you will face.<br />
FEATURING: rod mcKiinnes, Partner, Research Based Solutions | Fola Odejimi, Financial<br />
Planner, The Odyssey Group
12:30pm LuNcHEON & uSBc POWEr PANEL | “One Community”…<br />
Joint Ventures and Sub Contracting Opportunities With Other<br />
Minority Groups. our panel will not only share practical perspectives on why and<br />
how to form partnerships, what partners look for, and leveraging agreements and<br />
joint ventures; they will also discuss future project opportunities for you to<br />
maximize and capitalize.<br />
2:30pm BrEAKOuT SESSiONS<br />
3:30pm Break<br />
MODERATED BY: commissioner Sandra D. Kennedy, Arizona Corporation Commission<br />
ENTrEPrENEur TrAiNiNg | A Healthy Workforce Should Lead to a<br />
Healthy Economy. This workshop is the first step on the path of personal responsibility<br />
for our individual and collective health and well-being. YYou will learn quick and easy stress<br />
reduction techniques to implement at the office, improve quality of life as well as bottom-line<br />
results, by learning how to handle stress before it handles you!<br />
FEATURING: maria mitchell, Acute Care Managment Supervisor, Mercy Care Plan |<br />
Tomás León, Chief Executive Officer, People of Color Network | Stephan E.<br />
Dannenbaum, Ph.D., Director of Integrated Health and Analytics, Magellan<br />
Health Services.<br />
BuSiNESS DEVELOPmENT | Board Development. organizations are<br />
becoming more adept at planning, but have not simultaneously learned to orchestrate<br />
and lead their organizations and people through the inevitable changes that must take<br />
place. This workshop gives leaders the tools to understand the change process and the<br />
framework for leading their agency and its people through the cycle of change.<br />
FEATURING: Karl gentles, President, KG Public Relations | Dana campbell Saylor,<br />
Chief Executive Officer, YWCA<br />
YOuNg ENTrEPrENEurS | Mentorship Programs. good mentoring depends on<br />
having a collaborative, reciprocal learning relationship with your mentor. There are several<br />
basic questions that you should ask, which may help you decide whether or not you are ready<br />
to start a particular business. This introductory session is designed to alert you to key points<br />
that you may not have considered yet, as well as, assist you in successfully addressing some<br />
of the initial changes that you may encounter.<br />
FEATURING: roxanne Banks, Regional Director, INROADS | Todd Weinstein, Director<br />
Leadership Development, PetSmart<br />
3:45pm BrEAKOuT SESSiONS<br />
ENTrEPrENEur TrAiNiNg | Operation Know How...the in’s and out’s of<br />
Business Law & Contracting & Licensing. knowledge of the general principles of contract<br />
law is important especially to clarify and facilitate commerce. This workshop will expose<br />
participants to the fundamentals of contract law, and assist in understanding customs and best<br />
practices in contracting and the licensing needed to get you ready to compete.<br />
BuSiNESS DEVELOPmENT | Where Are You In Your Insurance and Risk<br />
Managment Plan? Are your insurance costs too high? Master all the insurance and risk<br />
management facts, strategies and how-to techniques you need to gain full, confident control<br />
of your program! In this workshop you will learn everything you must know about coverage,<br />
cost, liability limits, retention and broker services/compensation. Be sure to bring your company<br />
policy—and your questions—for discussion!<br />
YOuNg ENTrEPrENEurS | Financial Literacy...Get Your Busniess Started.<br />
Many people who want to start a business cannot reach their goal because of poor credit, lack of<br />
savings and a lack of understanding about the basics of money management. Come and learn<br />
the basics of banking, credit, financial planning, money management and saving and investing.
4:30pm<br />
Friday | 11.9.12<br />
TOWN HALL | Why <strong>Black</strong> <strong>Chamber</strong>s? In order for our communities<br />
to grow, there must be strong black businesses. in order for black businesses<br />
to grow, there must be strong black chambers. America’s economic future is so<br />
inextricably linked with minority and immigrant groups that investment in black<br />
chambers of commerce is essential.<br />
MODERATED BY: Derek T. Dingle, Senior Vice President/Editor-In-Chief,<br />
BLACK ENTERPRISE Magazine<br />
5:30 - 7:30pm Networking Reception<br />
9:00am - 5:00pm EXPO & <strong>cArEEr</strong> FAir<br />
[FREE AND OPEN TO THE PUBLIC]<br />
will feature: Career Placement opportunities | Raffles | <strong>Black</strong> <strong>Chamber</strong> LiVe TV Show<br />
“High noon Fashion Show” | Live Twitter updates | “MoB oUR MeMBeRS” | Life coaching<br />
Professional Headshots | Resume Proofs | Mock interviews.....and much more!<br />
2:00pm - 3:00pm SmALL AND mEDium SizED BuSiNESS<br />
EDucATiON AND PrOFESSiONAL<br />
DEVELOPmENT STrATEgY.<br />
if you want to join the more than 14 million self-employed Americans (Bureau of Labor<br />
Statistics 2011), then the Bachelor of Science in Business with a concentration in Small<br />
Business Management and entrepreneurship* degree program can help you gain valuable<br />
know-how. With coursework that includes advanced concepts in small business development,<br />
communications and management theory, you’ll be preparing to lead. Learn how University of<br />
Phoenix can help you prepare for the dynamic world of entrepreneurship. Also, we are<br />
developing programs and new products to serve this market across the United States.<br />
3:00pm - 4:00pm BuSiNESS TrAVEL SOLuTiONS SEmiNAr<br />
At United, we offer travel discounts and reward programs to individuals, groups, organizations<br />
and small to mid-sized enterprises interested in partnering with United to better manage travel<br />
spend while earning savings and rewards. We are committed to finding ways to bring added<br />
value when you travel.<br />
5:00pm PrE-SHOW<br />
6:00pm - 10:00pm Concert Under The Stars<br />
FEATURING GRAMMY NOMINATED ARTIST<br />
Johnny Britt<br />
with special apperances by n’dambi Blue & Marion Meadows<br />
produced by:
[SPonSorShIP oPPorTUnITIES]<br />
TITLE SPONSOR<br />
$40,000<br />
This exclusive Phoenix sponsorship level<br />
includes...<br />
1) Exclusive branding of Concert<br />
Under the Stars<br />
- Opportunity to deliver sponsor remarks<br />
prior to live performace at Concert<br />
- Corporate logo on concert tickets<br />
- Company name & logo included on all<br />
media impressions ( over 30,000 national<br />
impressions in radio, newspaper, and<br />
social media outlets)<br />
2) Premier Placement at Summit<br />
- Corporate logo on all event marketing<br />
collateral<br />
- Full inside cover-page ad in event<br />
program<br />
- Corporate ad to be displayed on main<br />
screen (as part of event powerpoint<br />
video)<br />
- Company logo on website<br />
- Opportunity to deliver welcoming<br />
remarks from the podium on Thursday<br />
- Opportunity to sponsor/present a<br />
workshop*<br />
- Opportunity to display organizational<br />
product, service or opportunity at the<br />
Expo & Job Fair (includes 2 eight foot<br />
tables in prime location)<br />
- (30) complementary full registrations<br />
and (30) reserved seats at the Luncheon<br />
& Concert<br />
- Opportunity to sponsor / brand Summit<br />
Registration Bags<br />
- Recognition in the both the <strong>US</strong>BC<br />
President’s Message & the GPBCC News<br />
& Events newsletter<br />
- Sponsorship of (5) regional chamber<br />
leaders & their top business owner<br />
- One-on-one match-making opportunity<br />
with local top business owners<br />
- 12 Month Membership in both the <strong>US</strong>BC<br />
& GPBCC<br />
GOLD SPONSOR<br />
$10,000<br />
- 12 month membership in the GPBCC<br />
- Corporate logo on all event marketing<br />
collateral<br />
- Company name & logo included in all<br />
regional media impressions ( over 10,000<br />
national impressions in radio, newspaper,<br />
and social media outlets)<br />
- Full-page ad in event program<br />
- Corporate ad to be displayed on main<br />
screen (as part of event powerpoint<br />
video)<br />
- Company logo on website<br />
- Opportunity to sponsor and present in a<br />
workshop*<br />
- Opportunity to display organizational<br />
product or service at the Expo (includes<br />
2 eight foot tables; power and wifi will<br />
come at an additional cost)<br />
- (10) complementary full registrations<br />
and (10) reserved seats at the Luncheon<br />
& Concert<br />
- Sponsorship of (1) regional chamber<br />
leader & their top business owner<br />
- One-on-one match-making opportunity<br />
with local top business owners<br />
- Opportunity to provide branded keepsake<br />
for participants<br />
Silver Sponsor<br />
$5,000<br />
- Corporate logo inclusion on promotional<br />
event marketing collateral and event<br />
program<br />
- Corporate ad to be displayed on main<br />
screen (as part of event powerpoint<br />
video)<br />
- half-page ad in event program<br />
- Company logo on website<br />
- Opportunity to present in a workshop*<br />
- Opportunity to display organizational<br />
product or service at the Expo (includes<br />
1 eight foot tables; power and wifi will<br />
come at an additional cost)<br />
- One-on-one match-making opportunity<br />
with local top business owners<br />
- (5) complementary full registrations<br />
and (5) reserved seats at the Luncheon<br />
& Concert<br />
CORPORATE SPONSOR<br />
$3,000<br />
- Corporate logo inclusion on promotional<br />
marketing collateral and event program<br />
- Opportunity to display organizational<br />
product or service at the Expo (includes<br />
1 eight foot tables; power and wifi will<br />
come at an additional cost)<br />
- (4) complementary full registrations<br />
and (4) reserved seats at the Luncheon<br />
& Concert<br />
ExPO VENDOR<br />
$500<br />
- Recognition in promotional marketing<br />
collateral and event program<br />
- Opportunity to display organizational<br />
product or service at the Expo (includes<br />
1 eight foot table and 2 chairs; power<br />
and wifi will come at an additional cost)<br />
- (2) complementary full registrations<br />
and (2) reserved seats at the Luncheon<br />
& Concert
[rEGISTrATIon InForMATIon]<br />
FULL REGISTRATION $75<br />
[Price increases to $100 after Friday, October 19th. ]<br />
Full conference registration fees cover your attendance at the summit; (1) ticket to the concert on Friday ; conference<br />
materials and session handouts; daily meals including morning and afternoon refreshments, luncheons and<br />
receptions.<br />
SUMMIT REGISTRATION ONLY $60<br />
CONCERT TICKETS ONLY $40<br />
[hoTEl ACCoModATIonS]<br />
Overnight accommodations can be arranged through: the marriott at mcDowell mountains<br />
16770 North Perimeter Drive | Scottsdale, AZ 85260 at the rate of: $159.00 per room (all rooms are suites).<br />
reservations must be made by Wednesday, October 24th, 2012.
R E G I S T R A T I O N F O R M<br />
Please completed and return this form to Heather Holmes via fax at 602.307.5204-or- scan and email to<br />
heather@usblackchamber.org. Payments can be mailed to: The Greater Phoenix <strong>Black</strong> <strong>Chamber</strong> of Commerce | 1201 E. Washington<br />
St., Suite 350 | Phoenix, AZ 85004 | 602.307.5200 [p]<br />
I WOULD LIKE TO REGISTER FOR:<br />
FuLL rEgiSTrATiON (includes summit and concert)<br />
[ early bird pricing ]<br />
____ @ $75 | Non-Member fee<br />
____ @ $50 | Member fee<br />
Note: Deadline to register at this price is october 19th, 2012.<br />
[ registration after Friday, October 19th ]<br />
____ @ $100 | Non-Member fee<br />
____ @ $75 | Member fee<br />
<strong>SummiT</strong> rEgiSTrATiON ONLY<br />
____ @ $60<br />
cONcErT TicKETS ONLY<br />
____ @ $40<br />
PLEASE ACCEPT THIS COMITTMENT TO:<br />
BE A SPONSOr @ $_________________<br />
BE A EXPO VENDOr<br />
____ $500 | Vendor Fee<br />
____ $50 | internet ____ $35 | electrical power<br />
iN-KiND SPONSOr ( Please briefly describe your in-kind<br />
support and the associated value of this donation)<br />
_________________________________________________<br />
_________________________________________________<br />
ORGANIZATION INFORMATION<br />
Key Representative:<br />
Organization Name: ___________________________________<br />
Prefix ______ First Name:______________________________<br />
Last Name:__________________________________________<br />
Title:________________________________________________<br />
Address:____________________________________________<br />
___________________________________________________<br />
City:______________________________ State:___________<br />
Zip:____________ Direct Phone________________________<br />
Email:______________________________________________<br />
Website:_____________________________________________<br />
PAYMENT<br />
PLEASE iNVOicE mE AT THE ABOVE ADDrESS<br />
ENcLOSED iS A cHEcK iN THE AmOuNT OF<br />
$ ___________________ Check # _________________<br />
crEDiT cArD<br />
Card Type: VISA | MC | DISCOVER | AMEx<br />
Card : ______________________________________________<br />
Expiration Date: ____________ Security Code: _____________<br />
Signature: __________________________________________<br />
Should you have any questions, please contact Heather Holmes, Conference Coordinator at: 602.538.7500 [d] -or- heather@usblackchamber.org.