Please fill out this form and send with payment by check,
money order or credit card information to:

Cowlitz Economic Development Council
1452 Hudson Street
P.O. Box 1278
Longview, WA 98632

You may also fax your request to:
Fax: (360) 423-1923

Event Registration

Event:

____________________________________________________

Number of Seats:

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Company:

 ____________________________________________________
Contact Person: ____________________________________________________
E-mail: ____________________________________________________
Title: ____________________________________________________
Mailing Address: ____________________________________________________
City: ____________________________________________________
State: ____________________________________________________
Country: ____________________________________________________
Zip Code: ____________________________________________________
Telephone: ____________________________________________________
Fax: ____________________________________________________
Web Site: ____________________________________________________
Business description: ____________________________________________________

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Payment Method:

__ Visa
__ Mastercard
__ Check

Credit Card Information:

Name on Card:________________________________________

Card Billing Address:___________________________________

____________________________________________________

Card Number:_________________________________________

Expiration Date:_______________________________________

Total Purchase:$______________________________________
Your Signature: _____________________________________________________
Today's Date: _____________________________________________________