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Name: * Title: * Company: * Address: * City: * State: * Zip Code: * Email: * Phone #: * Payment It is $125.00 to register for the "First Annual Harris County Trade & Transportation Conference." Please make checks payable to Corporation for Regional Excellence and reference “Harris County Event” in the memo section. Mail your registration form and payment to: First Annual Harris County Trade & Transportation Conference Houston-Galveston Area Council Attn: Gabriella Villegas 3555 Timmons, Ste. 120 Houston TX 77027 Fax your registration form to: 713-993-4557, attn: Gabriella Villegas Billing Information Billing Name Billing Address 1 Billing Address 2 Billing City Billing State AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY Billing Zip Payment Payment Type Mastercard Visa Check Card Number CVV Number Expiration Date 01 02 03 04 05 06 07 08 09 10 11 12 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Total: $125.00