Friday, April 16 and Saturday, April 17 2010
Holiday Inn Crown Plaza Hotel,
4300 East Washington Street in Phoenix.

INSTRUCTIONS:

You have two options for payment of registration fee:

1. Complete the form and submit the form and use PayPal on the Thank you page to make payment.

2. Complete the form, print this form, submit the form, and mail it, along with the exhibitor registration fee to the address listed at the bottom of this form. Registrations are due by Monday, March 15 to insure your company or organization is able to participate. Please contact Ron Brooks, Convention Coordinator at (480) 221-4387 or by email at ronlbrooks@msn.com with any questions.

TODAY'S DATE (MM/DD/YYYY):

Company Name

Contact Person’s Name

Phone Fax Email

Address

City State
Zip

Web site address

_______My company is a non-profit/government agency and I am requesting that the $100 fee be waived. Wave $100.00 Fee

_______I have enclosed a check for $100 to cover the exhibit fee. $100.00 Fee

I wish to sponsor additional convention activities. See cover letter for additional information and details. (Check the appropriate box)

_____$500 convention sponsorship Workship Sponsor $250.00

_____$100 to place materials in registration packets Material in Registration Packets $100.00

List of names of those staffing your area:

Comments:Type Names here.

Note, print this form for your records.

Method of payment (i.e. PayPal or Print and Mail) Using PayPal on next screen
Mailing Fee

Comments: Type comments here.

Submit will send an E-mail of this form to the AZCB.

If you have chosen to mail your payment:

Please mail this form and your check, payable to the Arizona Council of the Blind to:

Arizona Council of the Blind, Inc
2010 Convention Exhibitor Registration
3124 East Roosevelt Street Suite 4
Phoenix, Arizona 85008