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We wish to renew/join the Corporate Renaissance Circle at the following level: $10,000 Platinum $5,000 Gold $2,500 Silver $1,000 Bronze |
Payment (please check one): Check AmEx Visa MasterCard Discover Card Number _____________________________________________________ Name on Card ____________________________________________________ Expiration Date ___________________________________________________ Signature ________________________________________________________
Make checks payable to: |
Company Name: __________________________________________________ Company Contact: Mr., Ms., Mrs. ____________________________________________________ Title ____________________________________________________________ Address _________________________________________________________ City _____________________________________________________________ State ________ Zip Code ___________________________________________ Phone ___________________________________________________________ Fax _____________________________________________________________ E-mail ___________________________________________________________
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| For more information, or to join by phone, call: (248) 541-5717 ext. 3708 |
