UA FA26- School Registration- Broward

Name of School/Resource Provider

Name of Contact Person

First NameLast Name

Title

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Attending Representative #1

First NameLast Name

Representative Email

example@example.com

Attending Representative #2

First NameLast Name

Representative Email

example@example.com

Brief Description of Your School/Company

School/Resource Website

Type of School (check all that apply)

Education Level (check all that apply)

Type a Service Provider

What learning disability does your school/company best serve (please select all that apply)

Support Services Provided (Select all that apply.)

Do you accept the FES-UA or FES-EO Scholarship?

501(c)(3)

Registration - deadline to cancel for full refund is September 25, 2026

Tax Exempt - Table Registration

501(c)3

$375.00 Quantity

Tax Exempt - Additional Representative

501(c)3

$15.00 Quantity

Taxable - Table Registration

$375.00 Quantity

Taxable - Additional Representative

max of 1

$15.00 Quantity

Tax Exempt - Table Registration (Dade & Broward County)

Have a booth at both UASF locations.

$750.00 Quantity

Taxable - Table Registration (Dade & Broward County)

Have a booth at both UASF locations

$750.00 Quantity

Subtotal

Tax

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

School Partner Agreement:

By submitting this form, I consent and acknowledge the terms and conditions of the organization (UA School Fair). I confirm that I have been authorized to represent the company in submitting the information above.

Signature

Date