LA-ACS Exhibitor Registration Form

Exhibitor Registration Form

LA-ACS Virtual Annual Meeting | March 5-7, 2021
Company Name (as you want listed on your booth) *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Main Contact *

First Name Last Name
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Your main contact will create your virtual booth? *

Yes No
Name

First Name Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Supporting Fees

You will be able to create your virtual booth once payment is received.
Exhibitor Options *

Platinum Level - $3,500 Gold Level - $2,000 Silver Level - $1,500 Basic Exhibitor - $750 Unrestricted Educational Grant
Unrestricted Educational Grant Amount - We will create an invoice for you if paying by credit card. The invoice will be sent to your Main Contact above. *
Payment Information
Payment Option *

Check Credit Card
By Check
Please make check payable to the Louisiana Chapter ACS and send to:

LA-ACS
Attn: Janna Pecquet
2213 Danny Park
Metairie, LA 70001
Paying Unrestricted Grant by Check
Please make check payable to the Louisiana Chapter ACS and send to:

LA-ACS
Attn: Janna Pecquet
2213 Danny Park
Metairie, LA 70001
Company Name *
Exhibitor Levels
prev next ( X )
Platinum Level Exhibitor/Sponsor
$ 3,500.00

Gold Level Exhibitor/Sponsor
$ 2,000.00

Silver Level Exhibitor/Sponsor
$ 1,500.00

Basic Exhibitor Exhibitor
$ 750.00

Total

$ 0.00
Should be Empty:

Exhibitor Registration Form

Supporting Fees

Payment Information