ICM Virtual Summit Vendor Registration Form

1
Vendor Name* This field is required.
2
Contact Name* This field is required.
3
Business Name* This field is required.
4
Street Address
5
Street Address Line 2
6
City* This field is required.
7
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
8
Zip Code
9
Phone Number
10
Email Address* This field is required.
11
Business Bio* This field is required.Name of your business and what products/services do you sell/offer.
12
Social Media Handles* This field is required.Fill in the blanks with your social media handles.
Facebook
Instagram
TikTok
Pinterest
Twitter
YouTube
13
Virtual Booth Selection

Virtual Booths are rented on a first come, first served basis. Includes a permanent social media post on CoRo's pages each week leading up to the virtual summit, a 10 minute spotlight feature during the virtual summit, and a virtual booth on the website from the day you booth is paid until the end of the virtual summit.
14
Virtual Vendor Booth* This field is required.Includes a permanent social media post on CoRo’s pages each week leading up to the virtual summit, a 10 minute spotlight feature during the virtual summit, and a virtual booth on the website from the day you sign up until the end of the virtual summit.
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My Bag
0
My Bag
Great Product Name
$20
Quantity:1
Size:Small
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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
Virtual Vendor
$85.00Edit
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.
15
Invoice ID
16
Please upload your logo* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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17
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
Should be Empty: