Pay by check registration form
HOW TO REGISTER:

Step 1: Complete and submit the form below

Step 2: You must add up your total and input that number on the last line of the form.

Step 3: After you submit, an email confirmation will be sent to you.

Step 4: Print a copy of your confirmation email + mail check payable to: Empire State Footwear Association

Step 5: Mail confirmation + check to Ray LaRose ESFA 840 Rosewood Terrace Endwell, NY 13760

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Email *
Sales Rep Name *
Sales Rep Address *
Email Address *
Phone Number *
Mobile Phone
FEES
1 Table (included in show fee)
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SHOW AD
Additional 4 ft. table ($15 each)
Additional 6 ft. table ($15 each)
Subtotal cost for tables
TOTAL FEES
Full payment covering the cost of exhibiting must accompany this application by mailing it to Ray La Rose at the address provided above.
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