Please provide the following contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
URL

List attendee names for name tag preparation

List your type of business or products/services to be displayed

Are you a distributor? Yes No  Number of companies you represent 

Number of 6' draped booths [$225 before 3/1/07; $275 after 3/1/07] 

Need electricity for $25? Yes No

Will sponsor a student poster award in the amount of?  $25 $50 $75 $100 other

    Enter a different amount or idea for sponsorship  

Total amount submitting $