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Exhibit Rules Information Booth Layout Sponsorships Agenda Home

Vendor Registration Form

Please enter information exactly as it should appear in the Vendor Directory.

Company
Address
City/State   Zip  
Contact Name
Telephone   Fax Number 
E-Mail Address
Web Address

Company representatives at conference: (Please print names exactly as name badges should be prepared.) Booth fee includes 2 company representatives; additional representatives may register for $45 each.


1     Complimentary
2     Complimentary
3     $45 
4     $45 
5     $45 


REGISTRATION INFORMATION: Booths are sold and assigned on a first come/first serve basis. Click here to check the booth layout for availability. Please call 1-800-332-8117 if you would like to reserve any of the following booths: 88, 81, 74, 68, 62, 55, 48, 47, 127, 122, 114, 113, 112, 111, 103, 95, 87, 80, 73, 67, 61, 54, 40, 39, 38, 37, 36, 28, 18 or have any questions.

Booth # Requested   Alternate # 1   Alternate # 2  

Booth Type?  Portable  Table Top   

Electric Needs?     1-3 amps. ($20)     4-6 amps.(+$35)        7-10 amps.(+$50)     None.  

Special Needs?         
Product Description:

Are you donating a door prize?  Yes   No   
Interested in being a sponsor?   Yes    No   

Who should we contact about a sponsorship?  

Phone Number

PLEASE NOTE: all cancellations are subject to a $100 administrative fee. Sorry, but no refunds will be given after December 9, 2004.


Number of Booths?  @$399 = 
Electric Service?  @$20, $35 or $50 = 
Additional Reps?  @$45   = 
Deposit  @$100 Per Booth       Due with registration
Amount Enclosed    
Balance      Due 12/9/2004

PAYMENT INFORMATION:

Payment Type:
Purchase Order #:
Credit Card#:
Expiration Date:
Name on Credit Card:
Billing Address:

RETURN COMPLETED FORM WITH PAYMENT TO: Florida Police Chiefs Association, Fax Number (850) 219-3640 or mail to: Conference Registration, P.O. Box 14038,Tallahassee, FL 32317-4038

The undersigned hereby authorizes FPCA to reserve exhibit space in the World Golf Village Resort Hotel, St. Augustine, FL, for use by above company/organization during the 2005 Mid-Winter Conference. The undersigned agrees to abide by the Exhibit Rules and Regulations and contract and ensures that all representatives working in the booth are aware of the terms, conditions and rules pertaining to the exhibition.


Authorized Signature   Date  
Print/Type Name   Title 


FOR FPCA USE
Date Received      Booth#  

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