Add New Record in MySQL Database

You are registering for the following training.

Training Site: Express Scripts
Training Date: Saturday February 24th 2018
Training Address: 100 Parsons Pond Drive
City: Franklin Lakes, NJ 07417
Contact Name: Peter Brot
Contact E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
Additional Details: 9:00 Registration and Refreshments 9:30 Start of the Training. Please allow an extra 15 minutes to go through security upon arrival. Local Directions: Continue on Summit Avenue, which becomes Old Mill Road after traffic light. Continue on Old Mill Road for 1/2 mile. Entrance to site is on the right. Visitor Parking Lot #5.

Club Name
First Name
Last Name
Officer E-Mail

President
Vice President of Education
Vice President of Membership
Vice President of Public Relations
Secretary
Treasurer
Sergeant at Arms
Non Officer

Additional Information:

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