NENA-TEXAS CHAPTER u 2004 ANNUAL CONFERENCE
VENDOR REGISTRATION FORM
Company: _______________________________________________________________________________
Description of Business (i.e. mapping software, 9-1-1 equipment, etc.): ___________________________________
Contact: ___________________________________ Title: ________________________________________
Address: ________________________________________________________________________________
City: _______________________________ State:____________________ Zip Code: _________________
Phone: (______)___________________________ Fax Number: (______)____________________________
E-mail: __________________________________________________________________________________
Name(s) of person(s) working booth: Name 1:
Name 2: Name 3: ___
BOOTH INFORMATION
TOTAL AMOUNT
10×10 exhibit booth(s) at $550 each .$________________
10×20 exhibit booth (s) at $750 each .$________________
£ Electrical: $100 (one-time charge) .. . .$________________
£ Phone: $75 (hotel extension line) .. . . .$________________
TOTAL AMOUNT ENCLOSED: $_________________
PAYMENT INFORMATION
Payment (circle one): Check Credit Card Money Order
Account #: _____________________________________________ Expires: ___________/__________
Type of Credit Card (circle one): AMEX VISA MASTERCARD DISCOVER
Name (as it appears on credit card): ___________________________________________________________
Signature: ____________________________________________________________________________
PLEASE MAIL FORM WITH REMITANCE BY July 16, 2004:
Make check or money order payable to: NENA-TEXAS CHAPTER
Mail payment and registration form to:
Joe Rogers
West Central Texas Council of Governments
1025 EN 10th Street
Abilene, Texas 79601
Or fax to: Joe Rogers (325) 675-5214
For more information, please call:
Joe Rogers or Patti Davis (325) 672-8544
NOTE: All attendees must complete a Conference Registration Form and mail with registration fees to the address above.
THE NATIONAL EMERGENCY NUMBER ASSOCIATION TEXAS CHAPTER (NENA TEXAS CHAPTER) IS A NON-PROFIT PROFESSIONAL ORGANIZATION. OUR TAX ID NUMBER IS 76-0208338.