NAPSEC Exhibit Registration

 &

Space Agreement

2012 NAPSEC Annual Leadership Conference

Exhibit Date - January 16 2012

 Name

as you want it to appear on name badge

 Additional Representative(s)

at Booth

The exhibitor fee covers one person for the Welcome Reception, exhibit day and the wine tasting exhibitor reception. All other booth attendees must pay a guest fee - see below.

Name

Name

Exhibiting Organization

Description of Products/Services

Street Address

City/State/Zip

Phone

Cell Phone

for on-site use

Email

Exhibitor

Agreement

I have read the 2012 NAPSEC Exhibitor Terms and Conditions and understand that any audio, visual, internet and electricity needed for the exhibit will be arranged directly with the resort and paid for by the exhibitor.

I have read and agree

Competitors to

be located in a difference area

Check here if this is not an issue for you

Emergency Contact

Name

  Phone

Please indicate food Allergies, Vegetarian

 Guest(s) and/or Organization Representative(s)

The exhibitor fee covers one person for the Welcome Reception, exhibit day,  and the wine tasting exhibitor reception.  All attendees will be required to have a name tag to enter events.

Name

Name

Please indicate food Allergies, Vegetarian

 Please indicate guests/representatives name when providing this information.

Guest Fees

Please check

those that apply

Exhibitor Fee $600

Additional Fees (guest(s)/additional representatives at booth)

Welcome Reception - $45

Wine Tasting Reception - $35

Exhibitor

Registration

Amount Paid

Guest Fees

Amount Paid

Total Paid

Total Amount Paid

Pay By Check

 Please check here if paying by check

Mail Payment To:

NAPSEC, 601 Pennsylvania Avenue, NW

Suite 900 - South Building

Washington, DC 20004

Credit Card Payment

 Visa       MasterCard      American Express

Credit Card Number

Expiration Date

Name on Card

Total Paid by

Credit Card

Thank you for your registration.

Please make a copy

of your registration

for your files.

Return to Exhibitor Page

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