2012 HI-TEC Technology Showcase Online Exhibitor Registration Form
Firm name ('Exhibitor')
*
Address
*
City
*
State/Province
*
Zip/Postal Code
*
Country
United States
Canada
*
Corporate Web site URL
Name of person to receive exhibit information
*
Exhibitor contact e-mail
*
Exhibitor contact phone
*
Exhibitor contact fax
Exhibitor contact address (if different from firm)
Exhibitor contact city
Exhibitor contact state/province
Exhibitor contact zip/postal code
Technology Showcase Space Rental (select one)
1 8' x 10' booth - $1200 or
2 8' x 10' booths - $2200
*
List top three booth selections
*
Company name for booth sign
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Company city for booth sign
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Company state/province for booth sign
*
Conference Program Description (25 words or less)
*
Billing organization (if different from firm)
Billing address
Billing city
Billing state/province
Billing zip/postal code
Billing phone
Payment Method (select one)
Check
Purchase Order
Credit Card
*
Check Number
Purchase Order Number
Credit Card (select one)
Visa
Mastercard
American Express
Card Number
Expiration Date
Exhibitor agrees to the Terms and Conditions in the Application and Contract for Exhibit Space
yes
*
Fields marked with
*
are required.