2012 Conference Badge Form

Each exhibitor receives 4 badges per booth. Additional badges are $25.00 per badge and must be paid (by credit card) at the time this form is submitted. Note: badges printed on site cost $50.00 per badge.

Exhibitor badges are intended for company employees and volunteers who are at the conference primarily to staff the booth and/or present an exhibitor session. Any non-employee (teacher, faculty member, etc) who comes to the conference to attend sessions or for other job-related reasons must register at the regular conference rate as an attendee.

PLEASE SUBMIT THIS FORM BY March 1, 2012

Provide the following information:

Company Name:
(as you want it on the badge)
Address Line 1:
Address Line 2:
City, State, Zip:
Country:
Registration Names:
(Type each name on a separate line)

(*If more than 4 names per booth, complete the payment information below)
Total Number of Badges:
Person Submitting This Form: Mr. Ms.
Title/job/position:
Work Phone:
Fax:
E-mail:
Comments or Questions:

PAYMENT INFORMATION - *Fill out only if you have more than 4 names per booth.
Select Payment Method:
Visa       Mastercard      

Please note: we cannot accept American Express or Discover

Card Number:  Verification Number:     Exp. date: /

   

Our Contact Information:
Susan Shaffer
Exhibits/Advertising Manager
P.O. Box 1773
Carlisle, PA 17013-2896
Phone: 717-245-1977
Fax: 717-245-1976
Email: nectfl@dickinson.edu

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