Women’s Conference Vendor Booth and Registration Payment Form 2026 Women’s Conference Vendor Booth and Registration Payment Form Today's Date MM slash DD slash YYYY Business/Company(Required)Contact(Required)Billing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cellphone(Required)Email(Required) Booth (8×10) Booth rental fee does not include registration fee for conference. See Below.Booth Reservation Non-Profit Quantity Price: $100.00 Quantity Enter number of booths ($100 each)Booth Reservation For Profit QuantityEnter number of booths ($150 each) Price: $150.00 Quantity Electric Outlet Yes No (Due to limited space only single booths are available. Only Featured Sponsors will have a double booth)Services Provided (Please list service or health screenings you will provide).Individual(s) Registration QuantityReservations for less than 10 individuals to attend the conference ($70 per person). This fee covers breakfast, lunch, conference materials and seating. If you have 10 or more attendees, select “Corporate table for 10” and indicate the number of tables you would like. ** PLEASE NOTE, ATTENDEE REGISTRATION IS NOT INCLUDED IN THE VENDOR FEE** Price: $70.00 Quantity Corporate Table for 10 QuantityCorporate table seating for 10 is available for $650 per table. Price: $650.00 Quantity Total Names of AttendeesEarly bird checks must be postmarked on or before 6/30/2026. All other registration forms along with full payment need to be received by 8/30/2026 to: Marie Noall, Health & Wellness, 348 College Street, Suite 180, Bowling Green, KY 42101.Make checks payable to: The Medical Center. Payment must be received by 8/30/26 to reserve booth. Please note, we must receive both the Application & Check to reserve your booth. Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name
