:::MarketScout::: 2008 eInsurance Symposium

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Exhibitor Registration Form

Two Ways to Register; 1.) Online (here) 2.) Print and Fax form to (972) 934-4299 Download ExhibitorForm.pdf To pay by Credit Card and ensure prompt registration, a secure online payment form will be provided after this screen.
Required
* Company:		* Primary Contact:
* Address:		* Phone:
* City:		* Fax:
* State:		* Email:
* Zip Code:		* Company Website:

* Title for Badge (eg. CEO):

Description of your products and services for use in conference and on www.einsurancesymposium.com


Includes all general sessions, activities, exhibit pass, breakfasts, luncheons, and reception
1) Name:			ID Badge
ADDITIONAL REGISTRATIONS You may purchase additional registrations with a $100 discount ($195ea). MarketScout recommends that you make all purchases in advance to avoid delays in entering the exhibit hall. (Note: No one will be admitted to the exhibit hall without a badge.) If you need additional registrants please enter the number here that you will need. Plese enter the names of each person. Attendee 1 Attendee 2 Attendee 3 Attendee 4 Attendee 5
Comment/Question?
I HEREBY MAKE APPLICATION FOR EXHIBIT SPACE AT THE 2009 ENTREPRENEURIAL INSURANCE SYMPOSIUM. I HAVE READ AND AGREE TO ABIDE BY ALL CONDITIONS OUTLINED UNDER THE RULES AND REGULATIONS SECTION OF THIS CONTRACT. BY CLICKING THE [REGISTER] BUTTON BELOW I ACKNOWLEDGE THIS AS A VALID DIGITAL SIGNATURE AND BINDING BY THE LAWS AND REGULATION OF THE STATE OF TEXAS.
	Billing Terms		TOTAL:
			ACCEPT
1)Please read carefully all the conditions of the 2009 Entrepreneurial Insurance Symposium Rules and Regulations. Your submital of this form signifies that you understand and agree to abide by the terms and conditions stated in the Rules and Regulations. 2)MarketScout will send an email verification at the end of this form to serve as registration confirmation. After MarketScout has received the funds required for the event, an email verification and space assignment will be sent.