ARIZONA SOCIETY FOR HISTOTECHNOLOGY

1. ARIZONA SOCIETY FOR HISTOTECHNOLOGY EXHIBITOR REGISTRATION APPLICATION NSH Region VII and ASH Symposium/Convention, July 11 - 13, 2014 We do _______ do not _______ wish to exhibit. Please return this form even if not attending, as this will alleviate the cost of further mailings. Company name: ___________________________________________________________________ Address: _________________________________________________________________________ Phone: __________________________________ Fax: ____________________________________ email: ___________________________________________________________________________ Attending Representative(s): _________________________________________________________ Contact person (if other than above): ______________________________Phone:_______________ Space needed: Unmanned table, literature only $350.00ea $ _______________ 6’ table # of tables ________ $400.00ea $ _______________ 110 volt electrical outlet $ 50.00ea $ _______________ TOTAL $ _______________ Check enclosed YES ________ NO _________ Your check must be mailed by June 6, 2014 to guarantee space in the Exhibit Hall. A late fee of $100.00 will be assessed if payment is not received. PLEASE make check payable to ARIZONA SOCIETY for HISTOTECHNOLOGY Submit this application to: Karen Lahti ASH Exhibit Coordinator 1224 S. Buchanan Street Gilbert, AZ 85233 Please direct any questions to Karen Lahti. Cell: 480-236-6559 Karen@gateslinger.com Saturday luncheon ticket choice: ____________ vegetarian ___________ non-vegetarian Special requirements: _______________________________________________________________ _________________________________________________________________________________ If you wish to make an extra contribution indicate so below: YES NO Amount Sponsor a break ____ ____ $ ________ Sponsor t-shirt/jersey with company logo ____ ____ $ ________ Donate a door prize/registration giveaway ____ ____