2019
Sponsorship/Exhibitor Agreement & Selection Form - Part II
Method of Payment
American Express
MasterCard
Visa
Check #_________
Credit Card #: ____________________________ Exp. Date (MM/YY): _________ CVC #: ____________
Credit Card Billing Address: _____________________________________________________________
City: __________________________________ State: ___________________ Zip: _________________
Name on Card (Please Print): ____________________________________________________________
Signature (Required): ____________________________________________ Date: _________________
Attendee Registration Information
First Name: _________________________________ Last Name: _______________________________
Badge Name (if different from above): _____________________________________________________
Title/Position: ________________________________ E-mail: __________________________________
Phone: ________________________________________ Fax: _________________________________
Mailing Address: ______________________________________________________________________
City: __________________________________ State: ______________________ Zip: ______________
Additional Attendee Registration
First Name: _________________________________ Last Name: _______________________________
Badge Name (if different from above): _____________________________________________________
Title/Position: ________________________________ E-mail: __________________________________
Phone: ________________________________________ Fax: _________________________________
Mailing Address: ______________________________________________________________________
City: __________________________________ State: ______________________ Zip: ______________
Please send completed Sponsorship Agreement & Selection Forms Part I & II along with payment
Confirmations will be sent once approved. Sponsorships and exhibit booths are assigned on a first-come,
first-served basis and are non-refundable.
Tel: 972.934.4264
Email: [email protected]
Credit Card Payments:
Return with form to [email protected]
or fax at 972-934-4299
www.privateclientcouncil.com