CRWAD - Table Top Exhibit Application Form
Where and When:
Table Top Exhibits at the 2012 CRWAD Meeting, Symposiums, and Satellite Meetings
will be held December 1 – 4, at the Chicago
Marriott, Downtown Magnificent Mile, Chicago, Illinois. Table Top Exhibits will be during the CRWAD Meeting, Saturday Dec 1 through Tuesday Dec 4.
Application for table top exhibit space indicates the applicants willingness to abide by all accompanying table top exhibit terms and conditions, general regulations, as well as such additional rules and regulations as the CRWAD deems necessary to the success of the exhibition, provided these latter do not materially alter the exhibitors contractual rights. This application and table order will become a contract when counter-sign ed by the CRWAD Executive Director. Checks should be made payable to CRWAD.
Please note the Terms of Cancellation under Section C and the acceptability of exhibits under Section D of the Terms and Conditions as they will be strictly enforced.
Please down load, Complete and return by fax or email
1) TABLE TOP EXHIBIT
Exhibit during the CRWAD Meeting, Symposiums and Satellite Meetings, Saturday Dec 1 through Tuesday Dec 4.
a) Complete this Exhibit Application & Table Order Form and send to Dr. Ellis no later than October 22, 2012
b) Pay $1200.00 Exhibit fee to CRWAD.
c) Make check payable to CRWAD and mail to Dr. Ellis
2) PAYMENT DESCRIPTION
Table Top Exhibit includes two people plus in-hotel delivery of materials to CRWAD Office Storage.
CRWAD Meeting Exhibitor Fee (Dec 1–4) $1200.00, amount paid $ __________
I need a power strip: yes ____; no ____; (if yes, additional $75)
Amount paid: $ __________ ; plus power strip $75, for a total $ __________
Please remit on or before October 22, 2012 or current date.
3) TABLE(S) REQUEST: (regular draped table is 6' x 30") (draped counter-top height table is 6' x 30" but taller)
Select only one of the following:
One regular table ______; Two regular tables ______; One regular table, One counter-top height table ______
4) COMPANY INFORMATION
a. Company Name: ______________________________________________________________________________
b. Please email product description to CRWAD:
Please email a 50 word or less product description to Robert.Ellis@Colostate.edu . Include the name of your company and web site.
c. Company Contact Person Name: ______________________________________
Contact Person Email: __________________________________________________________
d. You can supply names until October 22, 2012. Personnel names can be changed once you arrive at the hotel with a request to Dr. Ellis.
Onsite Company Personnel Name: 1. ____________________________________________________________
Onsite Company Personnel Name: 2. ____________________________________________________________
e. Company Mailing Information
Company Name: _________________________________________________________________________________________
Mailing Address: _________________________________________________________________________________________
City: ________________________________________________________State: __________
Zip: ____________________Telephone: __________________________________ Fax: _________________________________
5) PAYMENT: Check OR Credit Card (circle one)
Make check payable to CRWAD and mail to the following address, or pay by credit card with the following information. Gift Contributors must add 5% fee to a credit card payment.
Credit Card Type: (circle one) Visa, MasterCard,
Discover, or American Express
Credit Card #: _______________________________________
Expiration Date: ______________________
Verification #: (The 3 digit number which appears on the signature
strip on the back of the credit card) ____
Street Address _____________________________________________Zip/Country
Code _______________
Name on Card _______________________________ Signature ___________________________________
Total amount paid: $__________________
Please include a Confidentiality Notice on the Cover Sheet when you fax your personal information. You may use the following statement:
"Confidentiality Notice – The content of this fax contains confidential information, intended only for the person(s) named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or any other use of this information is strictly prohibited. Please destroy the information immediately and all copies thereof. If you have received this fax in error, please notify us by telephone at 970–491–5740."
Total amount paid: $ _________________
Mail or Fax this application by no later than October 22, 2012, to: (Fax No. 970–204–6684)
CRWAD
Dr. Robert P. Ellis
Department of MIP, Campus Stop 1682
Colorado State University
Fort Collins CO 80523-1682
CRWAD Executive Director Signature: __________________________________________________________
