2010 IPCA Fall Conference
September 15-16, 2010
Northfield Inn, Suites & Conference Center
Springfield, IL
Below I am authorized to indicate for my company the top three (3) choices for booth space at 2010 IPCA Fall Conference:
1st
2nd
3rd
Booth Size
Member Fee
Non-Member Fee
8'x10'
$200.00
$300.00
Company/Organization Name:
*
Address:
*
City:
*
State:
*
Zip:
*
Email Address:
*
Contact First Name:
*
Contact Last Name:
*
Title:
*
Phone:
*
Fax:
Products to be exhibited:
*
Companies that I do not want next to my booth for competitive reasons:
Sponsorship Opportunities
1st Choice
2nd Choice
3rd Choice
Additional Badges
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Credit Card:
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Card Number:
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Security Code:
Expiration:
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Name on Card:
