Vendor Registration Form
Fill out the form carefully for registration.
Vendor Name
First Name
Middle Name
Last Name
Company
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Vendor E-mail
example@example.com
Mobile Number
Format: (000) 000-0000.
Work Number
Format: (000) 000-0000.
My Products
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( X )
Platinum Sponsor
Booth & 15-minute presentation to conference
$
1,000.00
Quantity
1
2
3
4
5
6
7
8
9
10
Gold Sponsor
Booth
$
800.00
Quantity
1
2
3
4
5
6
7
8
9
10
Please digitally sign that vendor contract located at https://nchia.org/wp-content/uploads/2022/07/2022NCHIAUpdatedVendorContract.pdf and upload it below:
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