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2012 Exhibitor Registration Form

Minnesota Veterinary Medical Association
101 Bridgepoint Way, Suite 100, South St. Paul, MN 55075
Phone (651) 645-7533 - Fax (651) 645-7539



Exhibiting Company
Name of Company:
Company Main Address 1:
Company Main Address 2:
Company City:
Company State:
Company Zip:
Main Phone:
Main Fax:
Company Website:

Contact At Company
Name:
Direct Address 1:
(if different than above)
Direct Address 2:
City:
State:
Zip:
Direct Phone:
Cell:
Direct Fax:
Email:
(required)

Local Contact
Name:
Direct Address 1:
(if different than above)
Direct Address 2:
City:
State:
Zip:
Direct Phone:
Cell:
Direct Fax:
Email:
(required)

Please indicate which contact should receive booth confirmation and further exhibitor information
 Contact at firm      Local Contact

Booth Size
 
Space
List your firm's
three booth preferences.
(See Hyatt Regency's floor plan.)
1.
2.
3.
Increase your chance of getting your 1st choice by becoming an Annual Meeting Sponsor.

If applicable, list companies
by which you prefer
not to be placed by:
Every effort will be
made to honor your request.

 
Is your organization a corporate member of the MVMA?
 Yes      No     Not Sure
Will your organization be a 2012 Annual Meeting Sponsor?
 Yes      No     Not Sure

Products/Services
Please list the
products/services
to be exhibited:

MVMF Silent Auction Item  Yes, we will provide an item(s) for the MVMF Silent Auction
Please list items


 No, we are unable to provide an item for the MVMF Silent Auction

Payment
Payment type:   Check     MasterCard     Visa     AMEX     Discover
Credit Card Number:     Exp. Date:
Security Code:     cvc code

Names of People Staffing the Exhibit (Must be employed representatives of company)
Email Kelly at kellya@mvma.org with names of further attending representatives.
1.
2.
3.
4.
5.
6.

Number of Friday Lunches Needed Total will be added to Booth Fee.
 

Minnesota Veterinary Medical Association
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