PRSM2010! National Conference Registration Form - Vendor Attendee by ihm18500


									  PRSM2010! National Conference Registration Form – Vendor Attendee
  April 18-20, 2010 | Rosen Shingle Creek | Orlando, FL
Part I - INDIVIDUAL INFORMATION (please print)

  First Name                                                                 Last Name                                            PRSM Member ID# (if applicable)

  Name as you wish it to appear on badge:                                    Nickname                                             Title

  Company Name


  City                                                                       State                        Zip                                   Phone

  E-mail                                                                                                              Spouse / Guest Name (if applicable)

Part II – REGISTRATION FEE SCHEDULE                                                                                                   Part III – HOTEL RESERVATIONS
                                                                                                                                          Name on Reservation:
                                                                                  Calculate Total Registration Fees:                      ______________________________________
 Vendor Member Attendees*
  Full Conference Sales Vol. more than $500,000            $1,500
                                                                                 Registration Fee:         $                             Dates for Reservation
  Full Conference Sales Vol. less than $500,000            $750                                                                          Arrival Date:
                                                                                  Spouse / Guest            $                             _____________________________________________
 Vendor Non-Members Attendees**                                                                                                           Departure Date:
  Full Conference Sales Vol. more than $500,000            $3,000                Welcome Reception             $                         __________________________________________

  Full Conference Sales Vol. less than $500,000            $1,500                Golf                      $________                     Room Type (select one): ��Single ��Double
                                                                                                                                                     ��Triple ��Double/Double
 Additional Tickets:***                                                           Grand Finale                  $
  Spouse / Guest                                           $250                                                                          Name of person(s) sharing room:
  Welcome Reception                                        $125                  Total:                        $                         ____________________________
  Golf                                                     $125                                                                          Special requests:
  Grand Finale                                             $125
 *PRSM membership dues must be current for 2010 to receive the member rate. Sales volumes will be verified to confirm
                                                                                                                                          ��YES! Please use the same credit card that is listed
 registration fees.
                                                                                                                                          below to guarantee hotel reservations.
 **Sales volumes will be verified to confirm registration fees.
 *** Welcome Reception and Grand Finale are included in Full Conference Registration.
   Credit Card                                                                                     Registration Policies:
                                                                                                         Payment: Registrations will not be processed without FULL PAYMENT. Payment must
                                                                                                         be made by major credit card or check in US dollars only. Please mail check payments
                                                                                                         to PRSM, P. O. Box 671247, Dallas, TX 75267-1247.
  Total Amount Due                                              Date                                     Membership: Membership dues must be current to receive member rate.
   AMEX  VISA            MasterCard                                                                   Lost/Stolen Badges: Lost or stolen badges are subject to a $100 replacement fee.
                                                                                                         Badge replacement fee is non-refundable.
                                                                                                         Spouse/Guest Registration includes access to the Sunday Welcome Reception, both
  Credit Card#                                     Expiration Date         Security Code                 Keynote Addresses (Monday and Tuesday) and the Tuesday Grand Finale. To attend
                                                                                                         the Tuesday Grand Finale, an additional ticket must be purchased for $125 online. A
  Name as it appears on Card                                                                             spouse/guest is an individual who is not associated with or employed in the retail
                                                                                                 facilities industry.
                                                                                                         Cancellations: There are no refunds for cancellations postmarked after March 15,
  Billing Address                                                                                        2010.
                                                                                                         Substitutions: All requests for substitutions must be made in writing with a complete
                                                                                                         registration form. Additional fees may be required based on the replacement’s
  City                                             State                    Zip                          membership status. Late substitutions will be processed on site after March 24, 2009.
                                                                                                         Membership dues must be current to receive the member rate. If you are not a
                                                                                                         member and would like to join PRSM Association, please complete Parts V & VI on the
  Cardholder’s Signature (Registration not valid without signature and payment)                          back side of this form. Once complete, add the amount due to the Membership line in
                                                                                                         Part II of this form.
                                                                                                         Sales Volumes will be verified to confirm membership dues.
                                                                                                         Membership Application: Please see sections V and VI of this form to complete the
                                                                                                         Professional Corporate (Vendor) membership application.

Part V – AFFIDAVIT OF COMPANY ANNUAL SALES VOLUME (Required for New Allied Corporate Membership in PRSM Association)
  I hereby declare and affirm the following:
  1.    Under PRSM Membership requirements, this company qualifies for Allied Corporate Membership.
  2.    Our company’s Total Annual Sales Volume* for this most recent fiscal year is equal to the category I selected in Section II of this form.
  3.    I declare that this information is current and accurate. Any information listed on this affidavit that is not correct may cause this PRSM membership application to
        be forfeited at any time without refund.
  Signed by: (Primary Member or Corporate Officer)
  Print Name:                                                                                  Title:

  Signature:                                                                                              Date:

                                                       Part V – SURVEY QUESTIONS

     1. Annual Sales Volume

     Up to $500,000     $500,000-5 Million
     $5-25 Million      $25-100 Million
     $100-500 Million   Over $500 Million

     2. General Category of Products/Services (Select up to 3)

 Maintenance Consultant Complete Service Management
    Doors    Electrical Fire Protection Flooring
    Glass/WindowsHVAC Janitorial Landscaping
 Lighting   Painting Parking Lots Pest Control
    Plumbing     Restaurant Maintenance Roofing
    Signage Security Waste Mgmt.

     3. Sales Region/Territory

     National U.S. & Canada National U.S.
     Northeast       Southeast   Midwest
     Southwest       Northwest

     4. Are you planning to exhibit at PRSM2010?

     Yes      No

     5. Would you like to receive additional information on PRSM Exhibit & Sponsorship Opportunities?

     Yes      No

     6. How would you prefer that PRSM contact you?

     E-Mail   Telephone

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