Vendor Registration Form

Vendor Registration Form

Last Registration Day - Sep 6, 2022
Event Date: November 5th, 2022

Time: 10am - 10pm

Event Address:Clark County Government Center Amphitheater
500 S. Grand Central Parkway, Las Vegas, Nevada 89154
Vendor / Employee Registration
Your Name

PrefixFirst NameLast Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Employees Attending?

YesNoOther
Guest Name

PrefixFirst NameLast Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.
Company/Corporate/Vendor/Exhibit Information
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Industry
Would you like to be updated about the upcoming events?

YesNo
Please verify that you are human.*
My Products
prevnext( X )
Vendor Fee Deposit / Base rate / promo vendor fee
$225.00

Total

$0.00
Signature

Clear

Pay with Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

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