Contact Name at your organization:___________________________________
Title:__________________________
(This is the individual with whom all arrangements should be coordinated.)

Firm Name:____________________

Mailing Address:________________________________________________________

City / State / Zip: ________________________________________________________

Phone: ( _____ )______________________ Fax: ( _____ ) ______________________

E-Mail:________________________________________________________________

Please list the person(s) who will staff exhibit booth. This information is needed for the badges we will provide.

Name:______________________________________

Mailing Address:________________________________________________________

City / State / Zip: ________________________________________________________

Phone: ( _____ )______________________ Fax: ( _____ ) ______________________

E-Mail:________________________________________________________________

Name:______________________________________

Mailing Address:________________________________________________________

City / State / Zip: ________________________________________________________

Phone: ( _____ )______________________ Fax: ( _____ ) ______________________

E-Mail:________________________________________________________________

Exhibit Requirements:

___ We do / ___ do not plan to use sound making equipment

We will require  ___ electrical hook up / ____ phone ____
Other (please specify) ___________________________________________________

Booth Registration Exhibit Fee(s)

Stand-Up Exhibit: $1,750 (subject to availability)                           $ ____________

Table Top Exhibit: $750 ($650 if paid by)                                        $ ____________

We will have __________ #  representative(s) handle our exhibit. $__No charge__

We will have __________ #  representative(s) also attend conference, conference meeting(s) and social activities. $400 each $____________

                                                                                                     Total $ _________________

Authorized Signature: __________________________ Date: ___________________