Printed from

JBN Reservation Form

JBN Reservation Form


jbn Atlantic.jpg

UPCOMING EVENT TUESDAY NOV 7, 2017, 8:30 - 9:30 AM
The Grand 2017 Executive Business Breakfast Event
Hosted at Rubie Corporate Plaza
Address: 400 Broad Hollow Road, Melville NY, 11747

First Name State
Last Name Zip Code
Company Name Email
Primary Contact Title Phone
Address Web Site *

Business Type * Business Description *


To suggest a new category please email

Register for the Nov 7, JBN Event

- $40
JBN Member (Fill out card info, card won't be charged) - $No Charge
Annual Membership - Includes Event Free
- $360
 RSVP with Promo Code   - Promo

Special opportunity to invite guest for only $10 a guest. Invite a table of 5 or more and join free. Please fill out all guest names below. Plus in addition, guest have to fill out their own forms using promo code "eliteguest" for $10 rate. (Guest rate is for one per company)

Number of Guest
Name 1   Name 5
Name 2   Name 6
Name 3   Name 7
Name 4   Name8......
Corporate Sponsorship OpportunitiesSilver - $ 500Gold -$ 770Diamond - $ 1000

Payment Options: (the card number has to be entered even if using promo code)

VISA MasterCard American Express
Card No.           
Card Zip Code:   
Check Date or Card Expiration: mm/yyyy / CCV Code:     

For more information call (631)-827-6599

Secure This page uses 128 bit SSL encryption to keep your data secure.