enrollment LEADForward Roundtable If you have any questions, contact Danielle Permenter, danielle.permenter@orlando.org. Invoice Payment 1Contact Information2Billing Information Invoice No.* Company Name* First Name* Last Name* Phone*Email* Payment Information*I understand that registering for AWE | LEADForward Roundtables is non-refundable and non-transferable. LEADForward registration fees to the Orlando Economic Partnership are not tax deductible as a charitable contribution but may be deductible as a business expense. Please consult your tax advisor. Federal I.D. # 59-1767933. I also acknowledge that as a AWE| LEADForward Roundtables participant, I will automatically be added to the Orlando Economic Partnership distribution list to receive emails about events, news, business opportunities and/or publications. I may remove myself from the distribution list associated with an email at any time by clicking the “unsubscribe” option on the email. I agree to the terms set forth in the card agreement and to the payment terms. I authorize the Orlando Economic Partnership to charge my credit card for the total amount due. LEADForward Participant | $4,800.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name Billing Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Zip Code Total $0.00 CAPTCHAConsent I agree to the terms set forth in the card agreement and to the payment terms. I authorize the Orlando Economic Partnership to charge my credit card for the total amount due for participating in the LEADForward Roundtables.CommentsThis field is for validation purposes and should be left unchanged. Δ