<p> Utah Mosquito Abatement Association 65th Annual Conference Red Cliffs Lodge Milepost 14, Hwy 128 Moab, UT October 28 – 30, 2012</p><p>VENDOR SUSTAINING MEMBERSHIP REGISTRATION FORM</p><p>Company Name: </p><p>Street or PO Box: Phone: </p><p>City: State: Zip Code: </p><p>E-mail: (If you want to receive e-mails about monthly meetings)</p><p>Quantity Total Cost</p><p>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</p><p>Sponsorship - Contact Randy Sessions for sponsorship options. (please specify – lunch, breaks, program, printing, audio/visual, reception, etc.)</p><p>Total</p><p>NO refunds will be given after October 23</p><p>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.</p><p>Those attending: Name: Title or Position</p><p>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] </p>