Mid-Atlantic Monument Builders Convention 2010

Company Name:______________________________________________

Address: ____________________________________________________

___________________________________________________________

Contact Person: ______________________________________________

Phone: ____________________   Fax: ____________________________

Email address: _______________________________________________

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Yes, I plan to display at the convention

# of booths: _______   $ per booth  (at this time you can order up to 3 booths)

Crating costs and # of units: ______ / ______  $ per unit (die & base or slant & base)

Advertising space in the booklet based on 8.5 x 11 black & white camera ready ad

Full page ($): ______ 1/2 page ($): ________ 

New ad or repeat: ______________________

Send ad or email ad to registration@mid-atlanticconvention.com

Names for badges: $ per person

________________________________   ________________________________

________________________________   ________________________________

________________________________   ________________________________

Send fees to Mid-Atlantic Monument Builders       Amount enclosed: __________
                    568 North Union Street
                    Middletown, Pa 17057

Credit card number: ___________________________________________________

expiration date: ________________________    security code: ___________________

Name on card: ____________________________________  zip code: ____________

All fees must be pre-paid to guarantee booth space!