Final Draft Dulles Regional Chamber Health Fair 2011
Hyatt Dulles Hotel
2300 Dulles Corner Blvd., Herndon, Virginia 20171
September 7, 2011, 9:00 AM – 2:30 PM
Deadline for vendor spaces is September 1, 2011.
Vendor Table Early bird price deadline is August 15, 2011.
Reservation Form Vendor space is limited. Reserve early to ensure your vendor table.
Name of representative(s) staffing your vendor table (as name should appear on vendor badge):
1st representative: _____________________________________________________________________
2nd representative: _____________________________________________________________________
Company contact: ____ Phone:
Vendor Table Price: By 8/15/2011 After 8/15/2011
Chamber member $100 $135
Non-chamber member $150 $185
Non-profit chamber member $35 $135
Will you need electricity? ___ Yes ___ No
Newsmaker Luncheon Tickets
Member $45 # of Tickets needed
Non-Member $60 # of Tickets needed
Total for vendor tables: $ _________________
Total for luncheon tickets: $ _________________
Total amount enclosed: $ _________________
Payment must be received to insure that a table will be reserved for you. Make check payable to the
Dulles Regional Chamber of Commerce and send to the Chamber at 3901 Centerview Drive, Suite R,
Chantilly, VA 20151. Credit card payments can be made by calling the Dulles Regional Chamber office
Please sign and date below that you have read the Application Terms and Conditions related to the date
of this event.