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Attendee Information
First Name
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Last Name:
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Company:
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Title:
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Email Address:
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Event Date
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Business Phone:
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Mobile Phone:
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Ok to Text?
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Yes
No
Event Registration Information
To help us select the best lunch options for you, please answer the following questions.
Are you a member of the JAX Chamber?
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Yes
No
Are you a member of the Three Rivers Council?
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🛈
Yes
No
Joining is easy! The cost to be a member of the Three Rivers Council is $35 per year. By joining today your registration and lunch at this event will be free. Would you like to join the Three Rivers Council?
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Yes, I enjoy a free lunch!
No, Please charge me for lunch!
At each of our events we hold a 50/50 raffle which benefits our scholarship program. Would you like to purchase raffle tickets for this event? (Raffle Tickets will be distributed at registration and are pre-pay only)
Raffle Ticket(s) - $1 Each
Event Selections
Annual Council Membership - $35.00
Member Event Registration - $25.00
Non-Council Member Event Registration - $30.00
Non-Member Event Registration - $30.00
Special Dietary Requirements
Do you have special dietary requirements?
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Yes
No
Please Indicate Special Dietary Requirements
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Vegetarian Meal
Gluten Free Meal
Payment Information
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