Request for Retailer / Foodservice Registration

Retailer / Foodservice Registration Request Form
This form is for Retail and Foodservice professionals who wish to request access to special registration opportunities for the Viva Fresh Produce Expo.

Submission of this form does not guarantee eligibility or confirm registration for Viva Fresh. All requests are subject to review and approval by the Viva Fresh Steering Committee. You will be notified once a decision has been made.

If approved, you will receive additional information and instructions to complete your Viva Fresh registration.

For questions please contact the TIPA office at info@texipa.org or +1 (956) 581-8632.
Name

First NameLast Name
Company Name
Job Title
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
PACA License
How many Stores or Distribution Locations does this Company own?
List Addresses of Stores or Distribution Locations:
Type of Operation?

Other
✈️ Do you need hotel and/or airfare assistance to attend this event?
Should be Empty: