Exhibitor Registration Form

ACOE Region 4 After School Bridging the Bay Conference
Bret Harte Middle School, 3700 Coolidge Avenue, Oakland, CA 94602
February 1-2, 2013 - 8:00am - 3:30pm

Exhibitor space is limited and will be provided on a first come, first served basis.

All registration fees are due by Friday, January 11.

Please fill out the following form completely and mail your check, payable to ACOE, to:
Freddie Hendrix, ACOE
Region 4 After School Programs
313 W. Winton Avenue
Hayward, CA 94544

Question Title

* 1. First Name:

Question Title

* 2. Last Name:

Question Title

* 3. Title:

Question Title

* 4. Business/Organization Name:

Question Title

* 5. Type of service(s)/product(s) offered:

Question Title

* 6. Non-profit 501(c)(3) number:

Question Title

* 7. Address:

Question Title

* 8. City:

Question Title

* 9. State:

Question Title

* 10. Zip Code:

Question Title

* 11. Email:

Question Title

* 12. Phone Number: (Please list the best number to reach you at)

Question Title

* 13. I would like to be a Sponsoring Exhibitor:

Question Title

* 14. I would like to be a Regular Exhibitor

Question Title

* 15. I will mail a check in the amount below to the ACOE office at: Freddie Hendrix, ACOE, Region 4 After School Programs, 313 W. Winton Avenue, Hayward, CA 94544

T