Fuel Cell Magazine and Fuel Cell Conference

Exhibitor/Sponsor Registration Form

Company:
Contact Name:
Title:
Address Line 1:
Address Line 2:
City:
State:
Zip:
Phone:
Fax:
Email:
Exhibit Contact (if different from above)
Contact Name:
Title:
Phone:
Fax:
Email:
Exhibit Space
	10x10 Exhibit Booth(s) - $1,995 each
	10x20 Exhibit Booth(s) - $3,800 each
	20x20 Exhibit Booth(s) - $7,600 each
Booth Number
First Choice	Booth Size:
Second Choice	Booth Size:
Booth separation is desired from the following companies (space permitting):
First:
Second:
Premium Sponsorship Packages:
Premium Package:
Sponsorship Packages:
Reception:
Luncheon:
Continental Breakfast:
Networking Break:
Conference Bag:
Lanyard:
Proceedings Binder Advertisement:

Total:	$0.00

Payment Method:
	An invoice will be sent for you to mail with the check
Card Type:
Card Number:
Expiration Month:
Expiration Year:
Card CVV Number:
Name on Card:
Billing Address 1:
Billing Address 2:
Billing City:
Billing State:
Billing Zip: