NAPM Orange County - Supplier Exposition - Registration Form

NAPM Orange County
Supplier Exposition - Registration Form
DATE - April 17, 2003 - Orange County Airport Hilton


Company Name		Contact Name / Title

Street Address		City, State Zip


Phone #	Fax #	E-Mail Address

Description of Product /
services to be exhibited -

Number of Table Spaces @ $250.00 Each Includes 6' table	$
Number of Dinner Reservations @ $30.00 per person	$
If you or your company are interested in becoming a Corporate Sponsor or in placing an advertisement on our Association website please enter the name of the person to contact. Contact Person:

Will you Require Power?		Power: @ $9.00	$
Yes	No	List special power requirements
Will you need a phone line?		Phoneline: @ $35.00	$
Yes	No	per line plus cost of calls
Total Amount Enclosed ( Payable to NAPM-OC )			$

Mail To:		Register By Credit Card:
Check or Credit Card Payment NAPM-Orange County 1651 East 4th Street, Suite 251 Santa Ana, CA 92701-5142 or Credit Card Payment Fax To: (714) 955-6979 Phone (714) 955-6978 / email		Card Type: AMEX Discover MC Visa
		Name on credit card:
		Card number:
		AMEX __ __ __ __	V Code	___ ___ ___
				3 digit code on back of card
		Expiration Date: Amount
		Authorized Signature:

Payment must accompany your registration. Space is limited. register early. Please return two copies with payment
last update 10/29/07	Our tax ID: 95-6069016