Supplier Registration

1. * Company:
2. Address/P.O. Box:
3. Suite:
4. City:
5. State/Province:
6. Zip/Postal code:
7. Country:
8. * Primary contact:
9. Phone:
10. Fax:
11. * Email:
12. Web site:
13. Attendee 1 name:
14. Attendee 1 title:
15. Attendee 1 email:
16. Attendee 2 name:
17. Attendee 2 title:
18. Attendee 2 email:
19. Attendee 3 name:
20. Attendee 3 title:
21. Attendee 3 email:

1. Full package ($3500) * How many? x $3500 FULL PACKAGE TOTAL: $ Attendees ($1500) ** How many? x $1500 ATTENDEES TOTAL: $ Presentation ($1000) How many? x $1000 PRESENTATION TOTAL: $ Tabletop ($1200) How many? x $1200 TABLETOP TOTAL: $ Spouse ($350) How many? x $350 SPOUSE TOTAL: $
2. TOTAL FOR CONFERENCE: $
3. Comments or questions?

Checks payable to:
WorldCan Conferences
1300 West Belmont Avenue, Suite 304
Chicago, IL 60657

Payments received after August 25, 2008 are subject to 10% surcharge. Non-payment will result in non-admittance to Conference. Presentations and tabletops are limited and will be reserved only upon receipt of payment.

Please supply the name of the person responsible for payment of above amount due:

On clicking the Register Now button below, the person stated above understands the terms and conditions listed on this web page.