Page 4 - 2018 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 – $1,995.00 8 x 15 – $2,695.00 10 x 16 - $2,995.00 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 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
cannot accepts 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—

SEE PAYMENT CHART $
— APPLICATION FEE
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

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80 ANNUAL CONFERENCE TRADE SHOW APPLICATION PAGE 4 OF 7
81 ANNUAL CONFERENCE TRADE SHOW APPLICATION PAGE 4 OF 7
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