Vendor Mail-In Registration 2016

Vendors wishing to participate in the 2016 MARCUMS Conference at Dickinson College October 13-14, 2016 will need to fill out the following form. Please register by August 31, 2016 to recieve the Early Bird Registration Rate. Enter "EarlyBird" (no spaces) below as your discount code. Thank you again for your continued support without you our conferences would not be possible.

Name*

First NameLast Name

Company Name*

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Office Phone Number

Area CodePhone Number

Cell Phone Number

Area CodePhone Number

	Yes	No
Rep Meal Attendance Thursday Lunch
Rep Meal Attendance Thursday Dinner

Booth Needs (Check all that apply)*

Table Skirt (8' Table)ElectricityOption 3

Name Additional Representative #1

Full NameE-Mail

	Yes	No
Additional Rep #1 Meal Attendance Thursday Lunch
Additional Rep #1 Meal Attendance Thursday Dinner

Name Additional Representative #2

Full NameE-Mail

	Yes	No
Additional Rep #2 Meal Attendance Thursday Lunch
Additional Rep #2 Meal Attendance Thursday Dinner

Name Additional Representative #3

Full NameE-Mail

	Yes	No
Additional Rep #3 Meal Attendance Thursday Lunch
Additional Rep #3 Meal Attendance Thursday Dinner

Please note any Dietary Restrictions:

Mail-In Registration (reference your email for coupon code)

Standard Registration$250.00

Literature Display (No Representative, No Discount)$75.00

Platinum Level Meal Sponsorship (This does NOT include Standard Registration)$500.00

Gold Level Meal Sponsorship (This does NOT include Standard Registration) $400.00

Silver Level Meal Sponsorship (This does not include Standard Registration)$300.00

Registration Bags (This does not include Standard Registration)$400.00

Stylus Pens (This does not include Standard Registration)$300.00

NameTags (This does not include Standard Registration)$150.00

Additional Representative (select once for each addtional representative)$50.00

Quantity

Enter coupon

Total $0.00