Utah Mosquito Abatement Association
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Utah Mosquito Abatement Association 65th Annual Conference Red Cliffs Lodge Milepost 14, Hwy 128 Moab, UT October 28 – 30, 2012
VENDOR SUSTAINING MEMBERSHIP REGISTRATION FORM
Company Name:
Street or PO Box: Phone:
City: State: Zip Code:
E-mail: (If you want to receive e-mails about monthly meetings)
Quantity Total Cost
Sustaining Membership (only need 1 per company) (does not include booth fee or meal tickets) $225 1 $225 Sustaining Membership - after October 19 $250 Convention Booth Fee $100 Banquet Ticket $38 Luncheon Ticket $15
Sponsorship - Contact Randy Sessions for sponsorship options. (please specify – lunch, breaks, program, printing, audio/visual, reception, etc.)
Total
NO refunds will be given after October 23
If booth space is desired, please indicate if a table other than 6’ is desired and if extra electrical outlets will be needed. Please respond as quickly as possible so we may accommodate your needs.
Those attending: Name: Title or Position
Hotel Registration: 1-435-259-2002 or 1-866-812-2002 Mail Sustaining Membership to: Eldon Rowley, UMAA Registration, PO Box 233, Hinckley UT, 84635 or [email protected]