Exhibitor [ ] Vendor [ ] _________________________________________________________________
Contact Person:____________________________________________________________________________
Address:_________________________________________________________________________________
City:______________________________________________________State: _________Zip_____________
Phone: (______)______________________________ Email:_______________________________________
Product
Description:________________________________________________________________________
________________________________________________________________________________________
Name of representative(s) at exhibit table for name badges:_________________________________________
Exhibit Table $150.00 each (includes coffee breaks) _____________
*For electricity, add $40 _____________
Sub Total:_____________
*Application will not be processed unless accompanied by required payment
Please find my check attached payable to DrSign in
the amount
of
$_____________________
or Visa or MasterCard ___
___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ - ___
___ ___ ___ Expiration _____/______
We hereby apply for exhibition space for the
Silent Weekend, June 23-26, 2011. If accepted, I/We agree to abide by
the conference terms,
conditions and regulations (click
link)
________________________________________________________________________________________ Signature Date
Please complete application and mail (check payable to Mike Tuccelli) to:
FULL
PAYMENT IS DUE
BY MAY 15, 2011
Questions
contact Mike Tuccelli DrASL@aol.com