VENDOR SPACE APPLICATION & CONTRACT


Instructions

Complete all sections of this application. 50% deposit must be submitted via credit card using this form. Send any remaining balance with with check made payable or credit card information to MBNA, 136 South Keowee Street, Dayton, Ohio 45402, fax (937) 222-5794,
info@monumentbuilders.org. All applications must include 50 percent payment to be considered for booth assignment.

COMPANY INFORMATION
I am a: MBNA Member    MBNA Non-Member
Company Name:
Company Address:
City:   State:   Zip:
Phone Number:
Fax Number:
Email Address:
Contact Name:
On-Site Representative(s):
Add'l Registration 1:
Add'l Registration 2:
Add'l Registration 3:
Add'l Registration 4:
 
VENDOR DISPLAY INFORMATION
Vendor Display Rates:
Members: The cost per vendor display is $625. Additional registrations (all individuals must be registered) cost $350.
Non-Members:   The cost per vendor display is $750. Additional registrations (all individuals must be registered) cost $420.
Total Number of Displays Requested:
 
Sponsorships: (please select)
Recognition Dinner - $2500        Keynote Luncheon - $2000        
Dessert Cruise - $2000        Awards Brunch - $2000        
Opening Reception - $2000        CM Luncheon - $1000        
Closing Reception - $2000        MBU Session - $500        
Other (please contact MBNA)        
 
Sub Total: $
 
Products and/or services to be exhibited:
 
Please select the category that best describes your company:
 
Please indicate your preferred table number: Click here to view map
1st:       4th:
2nd:   5th:
3rd:      
 
Please avoid (if possible) space assignment adjacent to the following companies:
 
If possible, we would like to be adjacent to:
 
PAYMENT INFORMATION
Total Due for Vendor Space: $
Total Due for Sponsorship: $
Less Total To Charge: $ (50% deposit required)
  (100% due if received after December 1, 2011)
Balance Due: $
 
Credit Card Type: Visa    MasterCard    American Express
Credit Card Number:
Expiration Date:
Name on Card:
 
 
 
Direct questions and/or payment to:
MBNA
136 South Keowee Street
Dayton, Ohio 45402
Phone: 800-233-4472
Fax: 937-222-5794
info@monumentbuilders.org