Vendor Registration Form

Name:    Phone:

Company:    Position/Title:  

Email:      Fax:

Mailing Address:

City:     State:    Zip Code:

  I wish to reserve 1 2 3 4 5 6 7 8 table(s) for $50.00/each at the Student Research Forum on Thursday, April 3, 2008.

  I will need access to 1 2 3 4 5 6 7 8 electrical outlets.

  I wish to contribute $ in support of the Appalachian Student Research Forum.

Method of Payment (select only one):

  Payment will be mailed.

  Payment will be made in person at the Forum.

  Bill my credit card (please print and fax form this form to us along with your credit card information including name on card, number, and expiration date).