2023 NBDA Conference: Exhibit Registration Form

Name*

First NameLast Name

Exhibitor*

Exactly as it will appear on media and printed materials.

E-mail Address*

$100 Small Vendor Full Table w/ Individual NBDA Membership$150 Small Vendor Full Table$200 Non-Profit Organization (State & Local)$300 National Non-Profit Organization$350 State & Local Government$450 For-Profit Organization, Education Institution, Federal Government

Yes (With Local Chapter)Yes (Member-At Large)No

Local BDA Chapter*

Name of current active Local BDA Chapter you are a member of. If your Chapter is not listed, please contact info@nbda.org.

You must select "$150 Small Vendor Full Table" Option. If you wish to become a member and pay for $100 Small Vendor Table, please visit join or renew your membership at https://www.nbda.org/content/membership.

Name of Representatives*

Include yourself.

YesNo

To attend the conference, please visit and register at Conference Registration (opens in a new window).

Special Location Request

.

Electrical or Wi-Fi Internet Request

Subject to additional charges depending on the speed request.

Questions/Comments

Include yourself.

Waiver & Hold Harmless Agreement

I * herby release and forever discharge the National Black Deaf Advocates, Inc., (NBDA), its Officers, Agents, Servants, and Employees, Heirs, Successors, or assigns from any and all actions, suits proceedings, debts, dues. Contracts, judgments, damages, claims, and/or demands whatsoever in law or equity which arise from my participation as an Exhibitor during the 2023 NBDA Conference on August 8-13, 2023 in Birmingham, Alabama.

In addition, I, the undersigned, agree to hold and save the NBDA, its Officer, Agents, Servants and Employees, their Heirs, Successors, or Assigns, harmless from any claims by any others, including cost and expenses for or on account of any all lawsuits or claims of any character whatsoever in arising from my participation as an Exhibitor during the 2019 NBDA Conference, including my travel to and from Birmingham, Alabama.

Furthermore, to the extent allowed by law, I acknowledge that my release, as expressly provided for herein shall apply to all minor dependents entrusted to me as matter of law.

Signature*

Credit CardCheck

Exhibit Pricing (Please note a transaction fee applied for credit card payment)*

Small Vendor Full Table w/ Individual NBDA Membership$102.56

Small Vendor Full Table$153.68

Non-Profit Organization (State & Local)$204.81

National Non-Profit Organization$307.06

State & Local Government$358.18

For-Profit Organization, Education Institution, Federal Government$460.43

Total $0.00

Credit Card Information
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Before clicking on "Register", please print this form by clicking "Print Form" on the bottom and enclose with the check in mail payable to:

National Black Deaf Advocates, Inc.
c/o 2023 NBDA Conference
1500 Chestnut Street, #2224
Philadelphia, PA 19102

We must receive the check within seven (7) business days unless you advise the specific mail date. Your registration may not be confirmed until the payment is received.

Click submit below to complete submission of your exhibit registration.