AIEA 2010 Conference * Washington DC (JW Marriott)* Feb 14-17, 2010
Sponsor and Exhibitor Registration Form
Space is limited and available on a first-come, first-served basis – return this form today to insure your exhibit space at the 2010 AIEA Conference. NOTE: This form must be completed fully and submitted with payment. Submit as soon as possible to reserve your exhibitor space. Organization Contact Name and Title: Name of Exhibitor: Billing Address: City, State, Zip, Country: Phone: Fax: Cell: E-mail:
Name of person to be listed in program:______________________ Email address to be listed in program: _______________________ Website URL to be listed in program: ________________________ Phone number to be listed in program: _______________________ Exhibitor Registration Fee of $1200 Includes: Listing in online conference booklet (available one year online) Full conference registration for one exhibitor One exhibitor and nametag One 6 ft covered table and two chairs Note: Booth electricity is an additional $75.00 – please email aiea@duke.edu to arrange
One person is covered under the $1200 exhibitor fee. Additional persons who will be exhibiting for the organization will need to register for the conference via the AIEA website Note: All persons at the booth must have their own conference name tag. One table per organization. Payment Info: ___Check is attached (payable to AIEA) OR __Credit card (details below)
For credit card payment: Credit Card type: ___ Visa ___ Mastercard Name on credit card: ____________________________________ Credit card number: ____________________________________ Credit card expiration date: ______________________________ NOTE: EXHIBITOR REGISTRATION CANNOT BE PROCESSED WITHOUT PAYMENT
Mail completed form WITH payment to: AIEA Secretariat, Box 90404, Duke University, Durham, NC USA 27708 Phone: 919-668-1928 FAX: 919-684-8749