1. Complete the demographic information below.

* Required information

* Company Name

Contact Information

* First Name:

* Last Name:

* Address 1:

Address 2:

* City:

* State:

* Zip Code:

* Phone:

Fax:

* E-mail:

Website:

Booth Registration

Booth 8' x 10' skirted tabled, two chairs, wastebasket. Includes lunches, breaks, and Thursday evening social for two people.

Early Registration (on or before April 3, 2009)

Booth ($750) Additional Booth ($500)

Booth ($850) Additional Booth ($600)

Non-Profit Organizations

Booth ($500)

Booth Selection

View the f loor plan

What are your choices for preferred booth number?

1st choice
2nd choice
3rd choice

Once payment is confirmed, Dolores Stephens will contact you regarding your booth assignment.

Attendance

Name Badges

Please list all participants that will require name badges. The booth fee includes lunches, breaks, and Thursday evening social for two people. Additional name badges can be purchased.

First Name	Last Name	Email Address	Attend Meals?	Which days is this person attending?
			Yes No

			Yes No

Additional Tickets

The booth fee includes lunches, breaks, and Thursday evening social for two people.

Meal and Event Package (both lunches, breaks, and Thursday evening social) for each additional person ($150)
Lunch and break each additional person ($50)
Thursday evening social event each additional person ($50)

First Name	Last Name	Email Address	Attend Meals?	Which days is this person attending?
			Yes No

			Yes No


			Yes No

			Yes No


			Yes No

Sponsorship

May 7th

Continental Breakfast ($4000)

Coffee Refresh ($1000)

Evening Event ($3000)

May 8th

Continental Breakfast ($4000)

Coffee Refresh ($1000)

Co-Sponsorship

May 7th

Continental Breakfast ($1000)

Coffee Refresh ($500)

Evening Event ($1500)

May 8th

Continental Breakfast ($1000)

Coffee Refresh ($500)

Door Prizes

Door Prizes (Raffle to be held at lunch May 7th and 8th.)

Program Advertising

Program is 8 1/2 x 11. Email camera ready ad.

Full Page ($400)

Half Page ($200)

Quarter Page ($100)

Business Card Ad in Program ($50)

Annual Meeting Program and Website

The information listed below will be in the Annual Meeting Program as well as on the website.

Product/Service Description for Program and Website:

Enter a concise, two-to-five line description.

Contact Information for Program and Website:

First Name:

Last Name:

Phone:

E-mail:

2. Acceptance of Terms and Conditions

I have reviewed and acknowledge acceptance of the terms and conditions which includes the cancellation policy, insufficient check funds policy, exhibitor agreement, and the credit card terms and conditions.

3. Questions or Comments

Do you have a question or comment? Please enter below and we will contact you.

If you would like a copy of this completed form, please print a copy before you select "continue" and continue with the payment process.

Payment options include: Credit card and check


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