NAHUC EDUCATION CONFERENCE

Tables for NAHUC Chapters and Region Exhibits

Group Name: ____________________________________________________________

Contact Person: ___________________________________________________________

Address: ________________________________________________________________

City, State or Province, and Zip or Postal Code: ___________________________________

Phone number: _____________________ E-mail:_______________________________

The cost of an exhibit is $25.00 per table (U.S. Dollars).

I agree to take full responsibility for setting up and removal of exhibit and hold NAHUC harmless for any loss incurred.

Signature:________________________________________ Date:____________________

____Check or money order payable to NAHUC enclosed

____Charge my: _____Visa _____ Master Card

Card #:__________________________________________ Exp. Date:________________

Signature (for credit card approval) _______________________________________________

Mail to: (Must receive by July 1, 2010):

NAHUC Program Committee
1947 Madron Rd
Rockford, IL 61107-1716
Fax: 815-633-4438

FOR NAHUC USE ONLY

Date received_________________________ ______ Approved

Amount $ received:_____________________ ______ Disapproved

Date reply sent:________________________