Digital Hollywood Working Group Contract March 28-30, 2006, Loews Santa Monica Beach Hotel Print Out and Return This Form Working Group Food Function Host - Group of 10 $2850 - Breakfast Group of 10 - Includes Food, Beverage and Complimentary Tickets to Digital Hollywood (All-Access 3-Day Pass) for 9 Attendees, plus one ticket for the Host $3250 - Luncheon Group of 10 - Includes Food, Beverage and Complimentary Tickets to Digital Hollywood (All-Access 3-Day Pass) for 9 Attendees, plus one ticket for the Host $4550 - Dinner Group of 10 - Includes Food, Beverage and Complimentary Tickets to Digital Hollywood (All-Access 3-Day Pass) for 9 Attendees, plus one ticket for the Host For Groups Larger than 20 call Victor Harwood at 212-352-9720 Agreement dated_____________________Between Digital Hollywood and Company_________________________________________________________________ Your Name ______________________________Title_____________________________ Address__________________________________________________________________ City_______________________________State_________________Zip_______________ Telephone_______________________________Fax_______________________________ email_____________________________________________________________________ Your Signature_____________________________________________________________ Working Group Topic (Choose Two) ___________________________________________ _______________________________________________________________________ Working Group Size (Circle One)____10_______15______20 Working Group Function (Circle One)____Breakfast_______Lunch______Dinner Preferred Day: (Circle One)___Sunday_____Monday____Tuesday_____Wednesday Working Group Host Fee $___________________ $_____________Amount Enclosed • Please Make Check Payable and Return To or Fax this form with Credit Card Information to fax: 212-206-0476 Digital Hollywood, 421 Hudson St., #320, New York, NY 10014. For Help call: 212-352-9720. Payment in U.S. Currency. If check is drawn on a foreign bank, add $50 for collection. Card Type: (Circle One)____AMEX______ __Visa______MasterCard Cardholder Name_____________________________________________________ Cardholder Nunber____________________________________________________ Expiration Date___________________________ Cardholder Signature__________________________________________________