Registration Form - Non-Exhibiting Suppliers

“The Power of Networking” is an excellent forum to connect corporate America with suppliers doing business in Southern California.
DATE / TIME: Thursday, September 16th, 2010 - 5:00 - 8:00pm
LOCATION: MWD Headquarters - 700 North Alameda Street, Los Angeles, CA 90012

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1. Name of Company:

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2. Name - Attendee #1

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3. Contact Number - Attendee #1

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4. Email Address - Attendee #1

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5. Name - Attendee #2

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6. Email Address - Attendee #2

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7. Contact Number - Attendee #2

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8. Name - Attendee #3

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9. Email Address - Attendee #3

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10. Contact Number - Attendee #3

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11. Name - Attendee #4

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12. Email Address - Attendee #4

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13. Contact Number - Attendee #4

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14. Brief product/service description:

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15. How did you hear about the event?

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16. Are you currently certified with the Southern California Minority Business Development Council (SCMBDC)?

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17. If you answered "no" to question 12, would you like to be contacted via email or phone call about becoming SCMBDC certified?

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