October 16, 2014
Melville Marriott
Exhibitor Space Registration Form
Please Print or Type)
Contact Name____________________________________________________________
Telephone_________________________________ Fax__________________________
Email__________________________________________________________________
Company________________________________________________________________
Address________________________________________________________________
No Refund for cancellations or if registrant does not attend.
Cost for Table: Members: $395.00 / Nonmembers: $625.00
(One 6’ skirted table and two chairs)
Cost for Premium Table: Members $595.00 / Nonmembers $695.00
(Two 6’ skirted tables, chairs and area for larger display)
If needed: Cost for Electric: $25.00
Internet (Wi-Fi access) can be purchased directly from the hotel and is not supplied by the expo.
Cost of Table________________ Electric Yes_______ No_______ Total Cost___________________
Payment Method (Check One)
Visa
MasterCard
Amex
Check/Cashiers Check/Money Order
________________________________________________________________________
Name As It Appears On Card (Please Print)
_______________________________________________ _______________________
Card Number
Expiration Date
______________
Security Code
_______________________________________________________
Complete Billing Address with Zip Code
585 Broadhollow Road, Melville, NY 11747
phone 631-777-6260 fax 631-777-6261