2013 Investigating Autism Conference Vendor Booth Application Form

Contract Person: Phone Number: (______) ... 2356 Drusilla Lane, Baton Rouge, LA 70809. Phone: 225.216.7474. Fax: 225.216.7977. All cancellations are ...
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2013 Investigating Autism Conference Vendor Booth Application Form Applications are processed on “First Come First Serve Basis.” You will be notified if your Agency has been selected. There are limited number of vendor booths available. Agency Name:______________________________________________________________________________ Contract Person:_______________________________________ Phone Number: (_______)___________________ Address:______________________________________________________________________________________ City:__________________________________________State:_________________________Zip Code:___________ Website: _________________________________________E-mail:________________________________________

YOUR APPLICATION FEE INCLUDES ONE 8-FT TABLE AND TWO CHAIRS. ALL VENDORS ARE REQUIRED TO DONATE A $25-30 DOOR PRIZE. Please list name(s) of representatives receiving complimentary registration below. Please note that all organization representatives will need to be registered through this application. Only two representatives per table. Any additional persons addition fees would apply. #1. _____________________________________________ #2. _____________________________________________

Method of Payment: For Profit fee: $25 Non-Profit fee: FREE o Check: (made to Families Helping Families of Greater Baton Rouge or FHFGBR) Please mark: Autism Conference. o Credit Card: o MasterCard o VISA Name on Card:________________________________ Card Number:_________________________________ CVC:_______________________Exp. Date:____/____ Authorized Signature:__________________________ Address if different than name listed above:_____________________________________________________

Complete form and send or fax to: FAMILIES HELPNG FAMILIES OF GREATER BATON ROUGE 2356 Drusilla Lane, Baton Rouge, LA 70809 Phone: 225.216.7474 Fax: 225.216.7977 All cancellations are non-refundable. OFFICE USE ONLY: Customer ID#__________ Receipt # ______________