Name of representatives setting up (include professional credentials) *
Your answer
Level of Sponsorship *
Will you need a table? *
Do you wish to donate items to the silent auction (This may be a sample
of your products, a gift certificate, or any item with a value of at least
$20.00)
Clear selection
If answered YES to donation towards silent auction, please list what you will donate:
Your answer
Food allergies? Please indicate Yes or No (for purposes of lunch the day of conference). *
If you answered YES to having food allergies, please list the allergies below:
Your answer
Please indicate any questions and/or special requests you may have below: