ICJC Womens Entreprenuer Event Entrepreneur EventPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Date: April 25th Time: 2:00 pm - 5:00 pm Where: Islamic Center of Johnson County Banquet Hall Before April 22nd: $50 After April 23rd or on-site: $75 Name *FirstLastPhone Number *Email *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBusiness NameInstagram HandleBusiness Logo Drag & Drop Files, Choose Files to Upload Will be used to help advertise by the media teamTable *Number Tables: $50.0012What service or items do you sell? Please list all *Refund *I understand that there is no refundsNo Sales Permitted *I understand that there is no sales permitted at this event. Please go to icjc.org/bazaar for the Bazaar registrationTotal$0.00Stripe Credit Card *Submit Payment
