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38th Annual NCPSMA Eastern Convention/Workshop September 22-25, 2010 Exhibitor Registration Form We have sold out of display spaces for 2010-You can still attend as a sponsor-call Roxie Mack at 336.366.4939 for more information. Please read carefully and fill out and return both pages. Please remember each person registering must pay $60-each. No free passes with display space purchase. Exhibitors are not allowed on the convention "floor" unless they are registered. Please make sure the check (we do not accept credit cards) is mailed with the registration form to be applied correctly. The check must accompany the forms for the postmark date to qualify for display space selection. There will be no refunds after September 2, 2010. PLEASE type or neatly print as name tags and company information will be printed in the program using this information. Please list the address, phone number and fax number you wish to have published in the convention/workshop program. Names of companies who do not attend but sponsor an event will also be published in the convention program. Information you wish to be published in the convention/workshop program: Company Name _______________________ Phone Number ___________________________ Address __________________________________Fax Number ____________________________ City ________________________________ State _________________ Zip ___________________ I need contact information in case of questions or an emergency situation such as postponement due to severe weather, so please list who to contact below. You can list “same” on phone and fax numbers if applicable. Contact Name _________________________ Contact phone number ______________________ Contact fax number ___________________ Contact e-mail address ______________________ Primary product or service your company provides ___________________________________________ Registration Names of those you are registering. The cost is $60 each-no free passes with display purchase. ______________________ _______________________ _______________________ ______________________ _______________________ _______________________ ______________________ ______________________ _______________________ If registering more than six people, please list names on a separate sheet and attach to registration form. Please remember you must register each person attending @ $60 each. No free passes with display space purchase. Please print or type. Display Space -Sold out for 2010 ($325 each for members -$450 each for non-members) Outside “is” Outside Courtyard Number of Spaces Requested. Please check appropriate box. ( ) One inside space Some companies such as lawn equipment sales wish to have an ( ) Two inside spaces outside (uncovered courtyard) space. Vendor rules (including ( ) One outside display size) are the same for inside and outside spaces. ( ) Two outside spaces Sponsorships $ ________________________________ Membership(s) Amount of membership(s) @ $20 each $ ________________________________ Please include completed Membership Form Amount Enclosed for Each Registration(s) $60 for each registration-no free passes $ ___________________________ Display Space(s) $____________________________ Sponsorship(s) $ ___________________________ Membership(s) $ ___________________________ Total Enclosed $ ____________________________ Make checks payable to NCPSMA. Mail to: NCPSMA 630 Adams Ridge Road State Road, NC 28676 Please remember to include both pages of the Registration Form.
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