Exhibitor Registration 2017 CMEA Exhibitor Registration Thank you for your interest in exhibiting at the 2017 CMEA In-Service Conference! When you complete this form and click "Submit", you will receive an email confirmation sent to the email address that you have included on the form. Step 1 of 8 12% Your Name* First Last Your Company or Organization*Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email* Please enter an Exhibitor Profile of 25 words or less for the Conference Guide.* I have a free-standing display and don't need any 6' tables.*YesNoI will send display materials to the convention center prior to the conference.*YesNoI will exhibit on Saturday.*YesNoName your organization's representativesTwo Representative Badges are included in the price for each Organization. Please list the names for the badges below. Representative #1 First Last Representative #2 First Last I will send names later by March 10 to firstname.lastname@example.org Do you need additional badges?*You may purchase a maximum of two additional badges for $50 each.YesNo Additional RepresentativesYou may purchase a maximum of two additional badges for your organization's representatives for $50.00 eachRepresentative #3 First Last Representative #4 First Last Is your organization a College or University?*YesNo Please choose the number of Exhibit Spaces desired*The booth rate shown is a special rate given to College/Universities only. Contact CMEA if you desire more spaces than the choices listed. email@example.comPlease Choose...One Space $275Two Spaces $375Three Spaces $475Four Spaces $550Number of Additional Badges Purchasing$50. each NoneOneTwoTotal Purchase $0.00 Please choose the number of Exhibit Spaces needed.*Contact CMEA if you desire more spaces than the choices listed. firstname.lastname@example.orgPlease ChooseOne Space $350Two Spaces $475Three Spaces $575Four Spaces $675Number of Additional Badges Purchasing$50. each NoneOneTwoTotal Purchase $0.00 Neither CMEA nor the CT Convention Center/Marriott Hotel assumes any liability for lost or stolen items. Please signal that you understand and agree to this policy by selecting "I agree and understand".*Security Guards will be present in the exhibit area when the exhibit hours have ended until the facility has closed.Please Choose...I agree and understand PaymentFollowing completion, your will be sent a confirmation to the email address you provided in this form.Total Purchase Amount $0.00 Select your payment method.Select oneCheck (Mail in to CMEA Exhibitor PO Box 174 Cromwell, CT 06416-0174Purchase Order (Mail in to CMEA Exhibitor PO Box 174 Cromwell, CT 06416-0174Credit CardThis page is unsecured. Do not enter a real credit card number! Use this field only for testing purposes. Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name Please mail a check made out to CMEA to CMEA Exhibits P.O. Box 174 Cromwell, CT 06416-0174Please mail your Purchase Order to: CMEA Exhibits P.O. Box 174 Cromwell, CT 06416-0174EmailThis field is for validation purposes and should be left unchanged.