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LSBA Exhibitors Request Form
Please complete the Exhibitors Form Survey and mail payment by Monday, March 4, 2019
*
1.
Name of Exhibitor
(Required.)
*
2.
Company Address
(Required.)
*
3.
Company Phone
(Required.)
*
4.
Email
(Required.)
*
5.
Contact Person
(Required.)
*
6.
Website
(Required.)
*
7.
Do You Require Electricity At Your Booth? ($40 Fee)
(Required.)
Yes
No
*
8.
A payment of $140 (with electricity) was mailed to the Department of Member Outreach and Diversity.
(Required.)
Yes
No
*
9.
A payment of $100 (without electricity) was mailed to the Department of Member Outreach and Diversity.
(Required.)
Yes
No
*
10.
Nametag Information (for those attending the CONCLAVE)
(Required.)
1
2
3
4
*
11.
If you understand and agree to the terms and conditions to exhibit at the 2019 Conclave, please enter your Company Name and Company Representative below.
(Required.)
Company Name
Company Representative (please type name)
