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! CONFERENCE
! ! ! !
Fee ! !
Selected ! ! PAYMENT INFORMATION
! !
OPTIONS! ! ! ! ! ! !
! ! ! ! ! ! ! ! ! TOTAL DUE =
!Presidents
! reception
! ! $1000
! ! ! ! ! Payment Method (circle) Check payable to NYSOTA
!Vendor Booth
! ! ! ! ! ! ! ! ! ! !
$400
! ! ! ! ! ! ! ! ! ! ! ! AMEX/ VISA/ MASTERCARD
!Full page! brochure
! ad ! !
$350 ! ! ! ! Card Holder Name: ________________________________
! ! ! ! ! ! ! ! ! Card Number: ____________________________________
!1/2 pg !
brochure !ad ! !
$200 ! ! ! ! Exp Date: _______________!Security Code: _________
! ! ! ! ! ! ! ! !
!CEU Presentation
! ! ! $250
! ! ! ! ! Authorization Sig & Date
! ! ! ! ! ! ! ! !
Conference Bag $200
!Stuffing ! ! ! ! ! ! ! ! ________________________________________________
! ! ! ! ! ! ! ! !
!Break Sponsorship
! ! ! !
$150 ! ! ! ! NOTE: Payment must be received before order can be processed.
! ! ! ! ! ! ! ! ! Please send to the address listed at the top of form.
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