Four Corners ABA Exhibitor Registration Form

Please submit by March 21, 2012

Space is limited! Please sign up immediately to secure an exhibitor table.

Contact Name
Address
City
State
Zip Code
Business Phone (XXX) XXX-XXXX
Fax (XXX) XXX-XXXX
Email Address
Our company would like to do the following (Check all that apply): Advertise in the electronic newsletter ($50). Please include information for printing (materials may be emailed to Michele Bishop at M.Bishop@centerforautism.com) We will need a full table at $200 (cost includes 1 free advertisement in the electronic newsletter and admission for 1 exhibitor).

additional exhibitors @ $100 per person. (Tables are approximately 6 feet in length)

We will need half a table at $100 (Cost includes 1 free advertisement in the electronic newsletter and admission for 1 exhibitor).

additional exhibitors @ $100 per person. (Tables are approximately 3 feet in length)

We cannot attend conference but would like to contribute marketing materials for distribution at the conference at $50 for distribution of up to 50 items
Names of Attending Exhibitors (1 free admission with half or full table)
Total Amount
(Pay via (1) check (address below) or (2) Paypal (after you submit))
$

If you would like to mail a check, please contact us for an address. Otherwise you can pay by credit card with PayPal.