•

•

S e

u

g National Convention & Conveniencec Store Expo n c (REG15 w/eml) February 17-19, 2015 e a s h Registration Mirage Convention Center, , NV s C (Please print) T h Company ______Name ______hroug 2nd Registrant [ mark if spouse] ______3rd Registrant [ mark if spouse] ______

4th Registrant [ mark if spouse] ______5th Registrant [ mark if spouse] ______

Address ______City ______State ______Zip Code ______

Phone (______) ______Fax (______) ______E-mail* ______* Remove e-mail from exhibitor mailing Request: I will require special accommodations for a disability. Attached is a statement regarding my disability-related needs.

ATTENDEE TYPE: Petroleum Marketer / Distributor / C-Store Operator Major Oil / Refiner Trade Show Exhibitor Fuel Transporter Full Registration (includes all events except golf) Save on Full Registration by registering Before 01/16/15 After 01/16/15 Principal Registrant ...... $460.00______$580.00______Spouse Registrant ...... $400.00______$465.00______Additional Registrant(s) ...... $400.00______$465.00______Daily Registration (does not include golf) Tuesday, February 17 Day Pass — Includes All Tuesday Events (except Golf) ...... $225.00______Wednesday, February 18 day Pass — Includes All Wednesday Events ...... $285.00______Thursday, February 19 day Pass — Includes All Thursday Events ...... $175.00______

Three-day Trade Show Pass (includes all events on Trade Show Floor) ...... $250.00 ______Wednesday TICKETED ITEMS (Included with Full Registration and Wednesday Day Pass) Opening Session 8:30 to 10:30 a.m. Keynote: Frank Caliendo – , and Impressionist . . . . .$ 85.00______Ladies’ Luncheon 12:00 p.m. “Hats Off to the Women of WPMA” – Delightful medley of all the hats we wear . . $ 70.00______

ATTENDEE TYPE: Manufacturer / Service Provider / Supplier

Non-Exhibiting Manufacturer / Service Provider / Supplier ...... $1,500.00______Non-Exhibiting Vendors: In an effort to protect the integrity of the show and to ensure the value of exhibit space atW PMA the endorsed policy of the show is as follows: Any non-exhibiting vendor who wishes to attend the WPMA Convention shall pay $1,500 per person. Non-exhibiting vendors who do not pay the fee will NOT be allowed to attend any convention events.

WPMA Scholarship Foundation Fundraiser (Does not include convention registration) Golf at Bear’s Best Golf Course (limited to 144 golfers) 8:00 a.m. four-person scramble Tuesday, February 17 Per Golfer Golf $225.00 ______Foursome Request: Golf without Convention Registration $285.00 ______Hole Sponsor** with 1 Golf Registration 1. ______2. ______$500.00 ______

3. ______4. ______Benefits WPMA Scholarship Foundation **For Other Golf Sponsor Opportunities go to www.wpma.com/national-convention/registration Grand Total $ ______Check Enclosed or Charge my: MasterCard Visa American Express Discover Account #______Exp. Date______Signature ______

Mirage Room Reservations: 1-800-499-6311 or 702-791-7444 • Room rate: $147 before November 13, 2014. • Make Convention & Expo checks payable to WPMA, mail with forms to: WPMA, P.O. Box 571500, Murray, UT 84157-1500 or • Fax with charge info to 801-262-9413 or • Call with questions to 801-263-WPMA (9762) or Toll-free 1-888-252-5550 • Save time – register on-line at www.wpma.com/national-convention. LAST DAY TO PREREGISTER IS JANUARY 30, 2015 Cancellation Policy: Notice of Cancellations for refund must be received in the WPMA office in writing by January 30, 2015. After that date, no refunds will be issued. A cancellation fee of 25% will be charged on all refunds. Refunds will be sent out after the conclusion of the convention.