Register by September 17th to receive a complimentary Java Jive mug!



Print out this registration form to RSVP for Java Jive 2010.


_____ YES! I will attend Java Jive 2010!


Enclosed is $_______ for _______reservations at $25 per person. ($12 per ticket is tax-deductible).


I would like to make an additional contribution of $_______


_____ I am unable to attend Java Jive, but please accept my donation of $_______.


How did you hear about Java Jive? ___________________________________


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Name:


Address:


City, State, Zip:


Phone:


Email:


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A check made out to the Rape Crisis is included with this form.

I would like to register by credit card.

Full name of credit card holder:_______________________________

Card #:________________________________

Exp. Date (MM/YY): ______________________

Please mail payment and registration form to 2801 Coho Street, Suite 301, Madison, WI 53713