Vendor Registration Form | OSSPEAC - Ohio Speech Pathology Educational Audiology Coalition

Vendor Registration Form

Company Name: *
Address 1 *
Address 2
City *
State *
Zip Code *
Contact Person *
Telephone # *
E-Mail *
Names of Representative(s) attending the conference *
Number of 8ft Display Tables w/Draping: ($350 prior to 5/30/09; $400 after 6/1/09; $100 Non-Profit *
Number of Feet Needed for Floor Display - $45/foot (please indicate 0 if not needed) *
Number of Electrical Outlets Needed - $25/plug (please indicate 0 if not needed) *
I would like to purchase box lunches for Monday (please indicate number)
Our Company/Organization would like to donate a door prize: *	Yes No
Our company/organization would like to donate an item to the Silent Auction: *	Yes No
I would also like to participate in OSSPEAC's Advertising Partnership *	Level 1-OSSPEAC Partner ($600) Level 2-OSSPEAC Conference Partner ($400) Level 3-OSSPEAC Friend ($200) Not interested at this time.
Our company/organization will be paying by *	Credit/Debit Card Check Purchase Order