Double Booth Registration

Organization/Company Name

As you wish it to appear in the conference program.

Organization/Company Description

Please include a brief paragraph about your organization and company products/services to be used in the conference program.

Organization/Company Website

http://

Organization Contact

First Name

Last Name

Organization Contact Email

Marketing Contact (If this contact is the same as your organization contact, insert X into the boxes.)

We will contact this person for logos and other marketing materials.

First Name

Last Name

Marketing Contact Email (If this email is the same as your organization contact email, insert X into the box.)

Attendee Registration Contact (If this contact is the same as your organization contact, insert X into the boxes.)

We will contact this person if there are any issues with your complimentary registration.

First Name

Last Name

Attendee Registration Contact Email (If this email is the same as your organization contact email, insert X in the box.)

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Do you require electricity?

Yes

No