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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 firstname.lastname@example.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 email@example.com 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 firstname.lastname@example.org If you do not receive confirmation/approval within 5 business days, please e-mail email@example.com 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.
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