Networking Event Registration "*" indicates required fields Date: Wednesday, December 13, 2023 Time: 6pm - 10pm Location: The Briarcliff Manor, 25 Studio Hill Rd, Briarcliff Manor, NY 10510 Includes buffet dinner, beer, wine, and soda.Ticket Type*RTA Member ($50)RTA Guest ($60)Name* First Last Company Name* Industry Category* Referral Source*Did an RTA member refer you to the group? If so, who? Otherwise indicate if you found us online or through social media. Email* Newsletter Subscription Please subscribe me to your email newsletter to be notified of future events and RTA announcements.Total Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Credit Card Billing Address* Street Address City 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 State ZIP Code Δ