SPDDS Midwinter Vendor Registration

Company/Organization Name (as you want it to appear at event)*
Name of Person Completing Form*
First Last
Title*
Email*
Phone*
Fax
Website
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Number of Representatives at Booth*
Name for name badge
First Last
Name for name badge
First Last
Name for name badge
First Last
Exhibitor Table
Price: $400.00
Number of Exhibitor Tables*
Electrical Outlet?
- Yes
- No
Would you like to donate an item for a door prize?
- Yes
- No
Please describe the item:
Space Choice #1
Exhibit space will include one six-foot skirted table and your company name attached to the front of the table. Please refer to this link for the floor plan (to indicate your preference on space): https://www.mndental.org/files/2019-Midwinter-Exhibit-Hall-Floor-Plan.pdf
Space Choice #2
Space Choice #3
Number of Luncheon/Program Tickets?
Price: $25.00 Quantity:
Total
$0.00
By completing this form you are agreeing to the Contract Rules and Regulations located at the link below.*
https://www.mndental.org/files/2019-Exhibitor-Contract-Rules-and-Regulations.pdf
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name