State Convention Exhibit Hall Registration Form

Contact 1

First Name First Name

Last Name Last Name

Street Address Line 1 Street Address Line 1

Street Address Line 2 Street Address Line 2

City City

State/Province State/Province

Postal Code Postal Code

Phone Number Phone Number

Email Email

Company Name Company Name

Website Website

Provide a description of the products/services your company offers. Provide a description of the products/services your company offers.

List additional information you would like included on the exhibitor list. List additional information you would like included on the exhibitor list.

Number of tables Number of tables

Number of chairs Number of chairs

Number of electrical outlets Number of electrical outlets

Payment

Payment/Exhibitors Category

$40 NFB Affiliate

$150 Non-Profits/State Agencies

$225 businesses

Registration Fee Registration Fee

If the person that will exhibit at our convention is different from the above named individual, please complete the below fields.

Exhibitors First Name Exhibitors First Name

Exhibitors Last Name Exhibitors Last Name

Exhibitors Job Title Exhibitors Job Title

Exhibitors Phone Number Exhibitors Phone Number

Exhibitors Email Exhibitors Email

Payment Information
Total	$ 0.00