Page 6 - 79th Annual Conference - Trade Show Application

Trade Show
Application

Company Information

Company Name (The name listed here is how it will appear in conference programs and signage.)

Address

City State Zip
The On-Site Booth Manager below hereby agrees to observe the“Policies & Guidelines”for the Trade Show.

Name of On-Site Booth Manager Phone
Signature of On-Site Booth Manager Email

Payment Information

Fee includes pipe and drape, display booth, table and two (2) chairs, and one (1) ID sign.

8 x 10 – $1,795.00 8 x 20 – $2,695.00 Booth Number:_____________

NABCA Application Fee Payment Information

Application will not be processed without an accompanying check made payable to NABCA or authorization to
bill your VISA, MasterCard or American Express. NOTE: Due to new Payment Card Industry (PCI) compliance
guidelines all payments with credit card information must be submitted via secure fax to (703) 824-3377
or mail. NABCA can no longer accept emails that include credit card information.

I hereby authorize the National Alcohol Beverage Control Association to charge my credit card for the amount below. In the case of any
issues or disputes concerning this transaction I will notify NABCA promptly to rectify the situation prior to notifying my credit card company.

PRINT CARDHOLDER'S NAME
AUTHORIZED SIGNATURE DATE

Internal Use ONLY Auth#______________ CC#____________________ Initial_________________ Date_________________

This portion of the form will be shredded immediately after processing.

CHECK ENCLOSED (payable to NABCA) —OR—
CREDIT CARD NUMBER $
EXPIRATION DATE AMOUNT

Return to: National Alcohol Beverage Control Association
4401 Ford Avenue, Suite 700, Alexandria, VA 22302
Secure Fax: 703.824.3377

Page 6 of 6 | 79th Annual Conference | Trade Show Application