ICM Virtual Summit Swag Box Registration Form

1
Contact Name* This field is required.
2
Business Name* This field is required.
3
City* This field is required.
4
State* This field is required.
Please Select
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
5
Email Address* This field is required.
6
What do you plan to add to the Swag Boxes?* This field is required.We would need at least 75 items; i.e.: business cards, product samples, flyers, etc.
Huge
Large
Normal
Small
Ok
Ok
7
Swag Boxes* This field is required.We'll be providing each attendee with a swag box full of products from our partners, and we hope you'll consider joining us!
prevnext( X )
My Bag
0
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
Total costUSD
Swag Bags
$50.00Edit
Back
Total cost $0.00
Payment Methods
Credit Card
First Name
Last Name
Cash App
After submitting the form, you will be redirected to the Cash App Pay to complete the payment process.
Google Pay
After submitting the form, you will be redirected to the Google Pay to complete the payment process.
Apple Pay
After submitting the form, you will be redirected to the Apple Pay to complete the payment.
8
Invoice ID
9
Important Event Information

Event begins at 12:00AM on AUGUST 11, 2023, and ends AUGUST 13, 2023 at 11:59PM. Prior to the event, I will send you a flyer with your information on it for promotional value.

PLEASE PROMOTE YOURSELF! I will do all I can, but to get traffic to the virtual mall, you have to make an effort as well. I cannot promise you that you will make a sale, but I will do all I can to get traffic to your site.

Make sure your links to your website are working, for I will not be held liable for your links not working. Any vendors who have not paid in full by SATURDAY, JULY 15TH, 2023, will lose their space (no refunds/no rain checks will be given).

Payment by CashApp ($ShopCoRo) and Square
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