Minnesota Veterinary Medical Association - Exhibitor Registration

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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:

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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