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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
1.Name of Company:(Required.)
2.Name - Attendee #1(Required.)
3.Contact Number - Attendee #1
4.Email Address - Attendee #1(Required.)
5.Name - Attendee #2
6.Email Address - Attendee #2
7.Contact Number - Attendee #2
8.Name - Attendee #3
9.Email Address - Attendee #3
10.Contact Number - Attendee #3
11.Name - Attendee #4
12.Email Address - Attendee #4
13.Contact Number - Attendee #4
14.Brief product/service description:(Required.)
15.How did you hear about the event?(Required.)
16.Are you currently certified with the Southern California Minority Business Development Council (SCMBDC)?(Required.)
17.If you answered "no" to question 12, would you like to be contacted via email or phone call about becoming SCMBDC certified?