NAPSEC Exhibit Registration & Space Agreement2011 NAPSEC Annual Leadership Conference Exhibit Dates - January 17 - 19, 2011 |
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Name as you want it to appear on name badge |
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Additional Exhibitor at Booth name as you want it to appear on name badge |
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Additional Exhibitor at Booth name as you want it to appear on name badge |
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Exhibiting Organization |
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Street Address |
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City/State/Zip |
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Phone |
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Cell Phone For on-site use |
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Fax |
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To be listed in conference program
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Emergency Contact While at Conference |
Name Phone |
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Email Confirmation Address |
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Attending Awards Luncheon |
put an X in the box if attending One luncheon attendee may attend with registration |
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Additional guest(s) Attending Luncheon |
Each additional luncheon Guest is $55 |
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Please Indicate Food Allergies Vegetarian |
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Description of Product/Services |
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Competitor(s) to be located in a different area |
List organizations
If not an issue - check here |
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| Exhibitor Agreement |
The undersigned agrees to the 2011 Exhibitor Terms and Conditions and understands that any audio, visual, internet and electricity needed for the exhibit will be paid for by the exhibitor.
Signature
Name (please print) Date
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Registration Fees |
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Registration $600 |
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Guest (s) For Entire Conference $250 Welcome Reception $35 Awards Luncheon $55
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Check |
Total Paid - mail to NAPSEC 1522 K Street, NW, Suite 1032, Washington, DC 20005 |
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Credit Card Payment |
Visa MasterCard American Express |
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Credit Card Number |
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Expiration Date |
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Name on Card |
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TOTAL on Card |
$ Total Paid by Credit Card |
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