Living With Autism Workshop Vendor Registration Form

Living with Autism Virtual Workshop 2020

(Just fill out the form below!)

Company Name*
Contact Person's Name*
First Last
Contact Person's Phone Number*
Contact Person's Email Address*
Website
Business Address*
Street Address Address Line 2 City State ZIP Code
Registration Type*
- Standard business: $650
- Nonprofit (we’ll ask you for your EIN certification): $500
Total
$0.00
Payment*
Please make your check out to Metro Parent, LLC and send to 22041 Woodward Ave., Ferndale, MI 48220. Must be received by Friday, Oct. 16.
Payment

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
With any questions or concerns regarding your credit card payment, call our accounting manager, Mary, at 248-955-9741 from 9 a.m.-5 p.m. Monday-Friday.
Billing Address*
Street Address Address Line 2 City State ZIP Code