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The Retail Loss Prevention Association of the Carolinas (RLPA)

August 22 Registration

REGISTRANTS
Company Name
First and Last Name
Guest Name
First and Last
Guest Name
First and Last		  
Guest Name
First and Last		  
Guest Name
First and Last		  
Guest Name
First and Last		  
Address
City, State Zip
Phone
Fax
*Email
 
REGISTRATION FEES
RLPA Member # Attending @$ = $
Total Payment To Charge:   = $
 
PAYMENT INFORMATION
Credit Card Type
Credit Card Number
Name on Credit Card
Exp. Date   SEC
 
Note: Lunch will not be provided after the meeting.

WAIVER OF LIABILITY

The undersigned, in consideration of his/her registration at the August 22 RLPA Meeting, releases, holds harmless and discharges the association, management staff and their agents, from any and all actions, claims and demands which may arise out of an accident, casualty or occurrence during said convention. Your signature below acknowledges acceptance of these provisions of registration for all those listed on this form.
Please type name in lieu of your signature:

 

 



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Carolinas Food
Industry Council



South Carolina Retail Association



Retail Loss
Prevention Association

 


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