Vendor Registration Form

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.
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
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

Should be Empty: