Niche Magazine Conference for B2B, Consumer and Start-up Publishers

Registration for Niche Magazine Conference

Full Name *
Job Title *
Magazine *	(note your most prominent magazine)
Company *
Address *
City *
State *
Zip *
Country
Phone *
Fax
Email *
Additional Registrants
Name
Job Title
Magazine

Name
Job Title
Magazine

Name
Job Title
Magazine

Name
Job Title
Magazine

Registration Rates:

Super Early Bird (Nov, 19 2008)
Super Early Bird Registration - $995

Multiple Super Early Bird Registration* - $945 (3 or more)

Early Bird (March 4, 2009)
Early Bird Registration - $1,095

Multiple Early Bird Registration* - $1,045 (3 or more)

Regular Registration
Registration - $1,195

Multiple Registration* - $1,145 (3 or more)

* You must register and pay for 3 or more people from the same company at one time

Credit Card Type *
	Mastercard
	Visa
	American Express

Credit Card# *

Expiration Date (mm/yyyy) *
/

Cardholder's Name *

(* Required)