Name of Exhibitor:

Your Email:

Phone:

Address

Description of Product/Service:

Will you be donating a door prize?  Yes No

Do you require an electrical outlet?  Yes No

Do you want to do a talk or demo?
(only 12 spots available - based on first come first serve for registration Yes No

If yes please give details:

Please indicate any special needs or requests (ie:to be placed next to another business...), we will accommodate those we are able:

Please type in exactly as shown