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APPLICATION FOR EXHIBIT SPACE

A. Your Information as person submitting form:

Your Name

Your Email

Your Phone Number

Your Street Address

Your City, State, Zip

B. Company information for exhibitors:

Name of Company:

Street

City

State/Province

ZIP/Postcode

Telephone

Authorized signature

Date

Type of merchandise to be displayed:

C. sales team information:

The committee would like the names and addresses of your sales representative. The sales representative registration fee, as noted below, is payable with this application. All sales representatives are required to wear our exhibitor badge in the convention hall and must have one in order to be admitted. Registration fee is non refundable. Sub-leasing of spaces is not permitted without approval of the committee.

Names, Address and Email of Sales Representative

D. raffle basket:

Thank you for your continued Generosity, Are you bringing a door prize raffle basket? (select one)

E. Sponsorship opportunity

Complete this section only if interested in being a WPFDA Convention Sponsor in addition to being an exhibitor

Is your company interested in being a Sponsor for this year's convention? (select one)

Sponsorship Level

Confirm amount of Sponsorship level here and in Amount C below

PLEASE PRINT THE NAME OF OUR COMPANY AS FOLLOWS

F. grand total and payment:

SPACE

8 x 10

NO.

AT $ 650.00

Amount A:

SALES REPRESENTATIVE(S)

Name(s)

No. of Sales Rep

@ $125.00

Amount B

SPONSORSHIP LEVEL

Amount

Amount C

*********************************Please enclose check in the amount of:

OR, If paying by PAYPAL (SEE SECURE PAYMENT OPTION BELOW:)

Select all that apply; Cart & Manual totals should be = to amount indicated to the right:

Amt. Total A-C (Manual calculate)

A COPY OF THE COMPLETED FORM WILL BE SENT TO THE CHAIRPERSON.

No form will be emailed to you beforehand, but is available upon request if you indicate that when you send in your check.

If you have a new company logo and/or in addition to being an exhibitor

are a PLATINUM, GOLD or SILVER Sponsor,

please submit your classified ad and/or logo in jpeg format to the

email: wpfda1@gmail.com

PLEASE MAKE CHECK PAYABLE TO:

WESTERN PENNSYLVANIA FUNERAL DIRECTORS ASSOCIATION

Rob Schellhaas

388 Center Ave.

Pittsburgh PA 15229

Contact: Ambassador Center 7794 Peach Street Erie PA 16509

1-877-866-3445 www.ambassadorerie.com

**KEEP 1 COPY OF CONFIRMATION EMAIL AS YOUR RECEIPT**

MUST SELECT ONE How are you paying? Secure paypal checkout OR print confirmation email and mail a check?NOTE - if using PAYPAL and desired sponsorship amount doesn't appear, a paper check will need mailed in for that amount along with a copy of the confirmation email.

CONVENIENTLY PAY SECURELY WITH PAYPAL

paypal payment

*If using PAYPAL and desired sponsorship amount doesn't appear, a paper check will need mailed in for that amount along with a copy of the confirmation email.

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