2024 DAD Vendor Form

Jan Lilly-Stewart Disability Advocacy Day at the Legislature Upper Rotunda Both Sides and Well - WV State Capitol Wednesday, January 17, 2024 Exhibit Form

8:30 a.m. to 9:00 a.m. 9:30 a.m. to 10:00 a.m.

12:00 -1:00 p.m. 2:00 p.m. Exhibits should be set-up by 9 a.m. and we request that you do not take them down until 2 p.m.

Set up displays. Rally Lower Rotunda Lunch (See Boxed Lunch Details Below) Take Down Displays

Organization

Address

City

County

State

Zip Code

Contact Person

Phone

Format: (000) 000-0000.

Fax

E mail

example@example.com

Please list the names of those attending the display table(s)

1.

2.

3.

4.

Due to the limited number of electrical outlets in the Capitol, we cannot guarantee that electricity will be available to everyone. When choosing your table, please remember! You can not run extension or other electrical cords across doorways.

Cost: Organizational Members: $50.00 Each exhibitor will receive one boxed lunch included with their exhibit registration fee. The box lunches will include a sandwich, cookie, chips and a drink.

Vegetarian.

Please check your choice for your free box lunch: Vegetarian.

I do not want any box lunches.

Turkey

Ham

Additional lunches are available for $9.00 each. (Please indicate how many extra lunches you need) Turkey #Ham # Vegetarian

Turkey

Ham

Vegetarian

The Fair Shake Network reserves the right to deny exhibitor participation based upon whether the organization reflects the mission and values of the Fair Shake Network. Please return this form with your payment by January 08, 2024. You can pay through PayPal by going to www.fairshake.org or make checks payable to Fair Shake Network, Inc. and send payment to: Fair Shake Network P.O. Box 354 Institute, WV 25112-0354