2012NMRESOURCEFAIRAPP by rJzlM9

VIEWS: 0 PAGES: 2

									    Autism Community Resource Fair Registration Form
New Mexico Walk Now for AutismSpeaks is seeking autism service providers to participate in our Resource
Fair on Sunday, October 28, 2012. Service providers and event sponsors will have the opportunity to provide
participants with information about autism services and organizations in their area. The Resource Fair will also
feature fun activities for children of all ages.
Registration cost for each booth:
 Non-Profit Rate: $75 if payment is received ON OR BEFORE early registration deadline October 5, 2012.
 For-Profit Rate: $100 if payment is received ON OR BEFORE early registration deadline October 5, 2012.
 FREE – Register a Walk Team and raise $1000.00 or more and the booth is free!
 $25 late fee for any payment received AFTER early registration deadline of October 5, 2012.

What you receive with your booth:
 10’ x 10’ tented booth space
 One 8-foot table and two (2) chairs will have drape on back of canopy.
 Access to a target audience
   PLEASE NOTE: Resource Fair participants are not permitted to sell items at the New Mexico Walk Now for
    Autism Speaks. You may provide giveaways to attendees, but sales are not permitted.

What your organization will need to provide:
 Appropriate signage for your booth
 Appropriate staffing
 One kid-friendly activity such as a carnival-type activity, coloring or arts and crafts project.

If you need ideas for or have questions about kid-friendly activities to provide, please contact Autism Speaks
at newmexico@autismspeaks.org or call 954-770-2631.

Schedule for Resource Fair participants (times subject to change):
 Vendor load-in starts at 6:30 AM
 Walker Registration and Resource Fair open at 8:00 AM. The walk ceremonies will begin at 9:00 AM.

NOTE: Resource Fair participants must have all necessary materials and supplies at booth location no
later than 8:00 AM on Walk day.
We also invite your organization to form a Walk Team or recruit additional volunteers for the day’s activities.
This will greatly increase your organization’s visibility during the walk. Contact Autism Speaks for a Walker
Registration Form and additional information, or register online at
www.walknowforautismspeaks.org/newmexico.


                      Please send your completed Registration Form to:
          West Region Autism Speaks 668 N. 44th Street – Suite 300 Phoenix, AZ 85008
                          OR email newmexico@autismspeaks.org
               New Mexico Autism Community Resource Fair Registration
____________________________________________________________________________________
Company/Organization Name:                               Service/Goods:
____________________________________________________________________________________
Website address (to be listed on Walk Now for Autism handout to participants)
____________________________________________________________________________________
Contact Name:
____________________________________________________________________________________
Title:                                                   E-Mail: (required)

____________________________________________________________________________________
Address:

____________________________________________________________________________________
City:                                   State:                    Zip:

_____________________________________________________________________
Phone :                     (to be listed on Walk Now handout)                            Fax :

 We would like to Walk Now for Autism Speaks! Anticipated # of walkers:_________
Team Captain Name: __________________________ Phone: (____)___________
 Registration Fees
   Non-Profit       $75 if registering by Oct. 5, 2012 (please include 501c3 letter)                  $
   For-Profit       $100 if registering by Oct. 5, 2012 (must be local small business)                $
 Electricity in your booth                    $25 Fee                                                 $
 * Add $ 25 if registering past early deadline (Oct. 5, 2012)                 TOTAL FEE               $
Describe kid-friendly activity you will provide: ___________________________
 We would like to donate goods or services.
Please Describe: _____________________________________________________________________

Payment :
Payment will be held until Walk Day and returned if your Team raises $1,000 earning a free booth.
Check: Please make payable to Autism Speaks              Check #_________
Credit Card        Visa        MasterCard           Discover           American Express
Credit Card# ____                                CID#_______ Exp. Date __                         _
Name on Card______________             Signature___________________________

(Billing address if different from above)

         Address:_____________________ City_______________ St_____ Zip______

                             All registrations are SUBJECT TO APPROVAL.

                       Please send your completed Registration Form to:
Autism Speaks, 668 N. 44th Street #300, Phoenix, AZ 85008 or email newmexico@autismspeaks.org

             If you do not receive confirmation/approval within 5 business days,
                         please e-mail newmexico@autismspeaks.org
             Autism Speaks is a registered 501(c)3 organization. Tax ID Number 20-2329938.
                      Donations are tax deductible to the extent allowed by the law.

								
To top