Name: _______________________________________________________________

Address: ____________________________________________________________

City: ________________ State: ___________ Zip:__________

Phone: _______________ Fax: _____________ Email: ____________________

Business Name: ______________________________________________________

Address: ____________________________________________________________

City: ________________ State: ___________ Zip:__________

Phone: _______________ Fax: _____________ Email: ____________________

Business type: (retail store, restaurant, etc) _________________________________________________

Number Attending: _____ x Price $______ = Total Payment: $ __________
Ticket prices: $50 before October 5th, $60 after October 5th.

Mail with check to:
APNBA
PO Box 5123
Portland OR 97208-5123

I am interested in:
Track 1 - Business District Development
Track 2 - Small Business Success

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ALLIANCE OF PORTLAND NEIGHBORHOOD BUSINESS ASSOCIATIONS, INC.
P.O. Box 5123 Portland, OR 97208-5123 503-234-7642, fax 503-282-0529
Email: info@apnba.com Website: www.apnba.com