District II Exhibitor Registration - E&I Cooperative Services

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October 15 - 18

Golden Nugget
Atlantic City, NJ

EXHIBITOR REGISTRATON FORM

First Name *

Last Name *

Company *

Title *

Address 1 *

Address 2

City *

State *

Zip *

Phone *

Fax

Email *

Website *

Principle Line of Business

Cooperative Affiliate

Name for Badge *

Additional Rep Name Badge 1

Additional Rep Name Badge 2

Additional Rep Name Badge 3

Additional Rep Name Badge 4

Full Conference Name Badge

BOOTH/SPONSORSHIP PACKAGES *

ADDITIONAL CHARGES

	Fee	Quantity
Additional Booth Representative	$60

Total Cost: $--.--

PAYMENT METHODS *

Credit Card

Card Holder Email NOTE: Please select the submit button below to proceed to the PayPal section for credit card processing.

Check

Mail Registration & Remit Checks
(made payable to Metro NY/NJ TIN# 14-1755402):

Attn: District II Exhibitor Registration
Rosaleen Cardillo, Metro NY/NJ Treasurer
Vassar College
124 Raymond Ave
Poughkeepsie, NY 12604

For questions about registration, please contact Karen Gallagher:
Phone: (845) 437-5845
Email: kagallagher@vassar.edu