Event:

Contact Name:

Salutation:	Mr. Mrs. Ms. Dr.
First:
Middle:
Last:
Suffix:
Job Title:

Full Registrant Name:

Salutation:	Mr. Mrs. Ms. Dr.
First:
Middle:
Last:
Suffix:
Job Title:

Exhibit Representative Only:

Salutation:	Mr. Mrs. Ms. Dr.
First:
Middle:
Last:
Suffix:
Job Title:

Company:

Phone:

( )

Cell Phone:

( )

Fax:

( )

E-mail:

* Required field

Website:

Member of:
AMTA
SEDA
IDA
SCMA
SWMOA

Special Needs:
Wheelchair Access
Visually Impaired
Hearing Impaired
Vegetarian Meals
Other

Sponsor:
Platinum: $10,000    Gold: $7,500    Silver: $5,000    Bronze: $3,500
Exhibit Reception: $1,000    Banquet: $750
Luncheon: $500    Refreshment Break: $375    Prize: $275

Exhibit Space Request:
(Allocated on a first come/first serve basis upon receipt of 10% deposit, full payment must be made by Jan. 31, 2009 or deposit and space will be forfeited))
Space Number: 1st Choice: 2nd Choice: 3rd Choice:
Please note that the Premium Booth Spaces are designated with an *

Premium Booth Space:
(Includes 1 Full Reg. and 1 Exh. Rep.)

Members/Affiliates (must be from the list above)

$2,300

Standard Booth Space:
(Includes 1 Full Registrant and 1 Exhibit Rep.)

Members/Affiliates (must be from the list above)

$1,800