Please enclose a copy of this invoice with your payment.

eMarketing Association
4259 Old Post Road - Charlestown, RI 02813

PHONE: 401.315.2194 FAX: 408.884.2461
REFERENCE # EV/EB - INVOICE

1 Event Registration for The eM12 Conference -

April 9/10, 2013 - San Francisco, CA- $1295.00

Please provide the following:

Date__________________

Name_________________________________________________________________________

Address________________________________________________________________________

City______________________________________State_______________Zip_______________

Company:______________________________________________________________________

Company URL:__________________________________________________________________

Phone #:______________________________________ Ext.:____________________________

Email Address___________________________________

Years of Marketing Experience: ______

Payment Method:

Visa ___ MasterCard ___ American Express___ Check___

Card Number_____________________________________________Expiration ______________

If Different From Above:

Name On Card__________________________________________________________________

Address________________________________________________________________________

City______________________________________State_______________Zip_______________

Signature:______________________________________________________________________