Business Conference Registration Form
Date

Membership:

Registration Fee: $
Representative 1:
Representative 2:
Company:
Address:
City:
State:      Zip Code: 
Telephone:  xxx-xxx-xxxx
E-mail:

Additional Representatives ($50 each)
1.         5.
2.         6.
3.         7.
4.         8.

Spouse/Child or Guest Registration for Meals ($20 for each meal)

Please list spouse or children attending Exhibit Hall Functions (Breakfast and Lunch)
Name:  $ (Only for spouse and children)
Name:  $ (Only for spouse and children)
Name:  $ (Only for spouse and children)
Name:  $ (Only for spouse and children)

Booth Information

Booth rental includes one table, two chairs, curtain backdrop, marker sign, security and registration for two.
Additional Booths: ($250 each for members/$400 each for non-members)
Additional Tables: ($30 each)
Additional Chairs: ($5 each)
Electricity/Telephone/Internet: Please complete form(s) and submit to convention center
Exhibit Hall Breakfast Sponsor: ($125)
Exhibit Hall Door Prize Sponsor: ($25)
Booth Preferences:
Diamond & Platinum Superboosters will receive priority booth
selection, otherwise in order of payment received.
Download Exhibit Booth Layout
 Choice 1) Choices are not guaranteed
Electricity included in booth fee
Choice 2)
Choice 3)
Attendee List:     $100 (Available after conference only)

Grand Total  $
Pay by Credit Card
Pay Later		 Credit Cards

Credit Card Information

First Name As it appears on card
Last Name As it appears on card
Billing Address
Billing City
Billing State
Billing Zip Code
Card Type
Card Number Enter number without spaces
Expiration Date mm/yy
Amount of Payment $
Do you want a receipt? Yes  No
E-mail Address