Vendor Registration Form

PRS 2025 Organization Registration

Incomplete Registration will not be accepted
Company Contact Information
Organization/Business Name
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Point of Contact

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
Organizational Overview
FULL Details of the Services you offer
Nonprofit or For Profit Entity
Establishment Date

MonthDayYear
Date
Website
WHO do you serve? Boys, Girls, Both, Adults. Ages? Please be specific
Please describe your payment options
Geographic Service Area
We are looking for organization who can offer on site registration thus complete intake process on the day of PRS event. Can you accommodate this requirement?
Insured?

YesNo
Licensed?

YesNo
Do you offer in person or virtual services
I hereby affirm that all information provided above is accurate to the best of my knowledge and belief, and I understand that this information will be considered material in the evaluation of your participation
Date

MonthDayYear
Date
Company Representative Signature

Clear
Should be Empty:

PRS 2025 Organization Registration