Additional Exhibitor Representative

Vendors that have already signed up to exhibit at a 2023 NCMPR district conference may either register an additional representative for a fee of $300. To secure your spot at the conference, complete this form and process payment by credit card prior to the conference date.

2023 Exhibitor Additional Representative Form

Please select an option:

District 1 Additional Company Representative: $300.00

District 2 Additional Company Representative: $300.00

District 6 Additional Company Representative: $300.00

SECTION 1 -- Primary Contact

This individual is the primary point of contact and will be contacted as needed for additional details.

First Name *

Last Name *

Job Title *

Business/Organization *

Address *

Address, line 2

City *

State/Province *

Zip/Postal Code *

Country *

Phone *

Email *

SECTION 2 -- Additional Company Rep

Please indicate the company rep that will attend the conference in-person. PERSON 2 is only applicable if purchasing for a total of two additional at one district conference.

NAME, PERSON *

Job Title *

Phone *

Email *

NAME, PERSON 2 (if applicable)

Job Title

Phone

I (we) agree to NCMPR's Exhibitor-Sponsor Terms and Conditions. *

Please respond to the following: * Required Field

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