25th Annual CUMSA Conference

 Online Vendor Registration 

*Registration approval will be confirmed within 24 hours through email.

 Registration approval shall be used as the invoice for check writing requirements.

     $300 One Vendor Space     $500 Two Vendor Spaces   $150 Information Table

(Registration  includes:  Vendor table, one lunch with conference participants and 3 min. vendor introduction to CUMSA)

Representative
Title
Company
Mail Address
City
State	Select a State Alaska Alabama Arkansas Arizona California Colorado Connecticut Washington D.C. Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missourri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
Zip code
E-mail
Phone
Fax

*Confirmation of registration form will be sent to the email address provided above upon submission of this form. 

Payment must be received no later than March 1, 2012 to reserve attendance.

   No additonal Vendor Lunch One additional Vendor Lunch $45 Two additional Vendor Lunch $90 /  Additional Lunch Vendor  include meal with participants

   Credit Card payments for CUMSA Conference

Enter any special request or comments in the provided space below: