Exhibitor Registration

I want to Reserve Exhibit Space(s)*

Yes
No

Choose YES if you want to reserve exhibit space(s) and complete the application that follows.

2019 Annual Joint Conference, WV-AWWA/WEA Canaan Valley Resort, Davis, WV

Submit Payment to:
WV-AWWA Attn: Christina Chard
1600 Pennsylvania Avenue
Charleston, WV 25302

Name of Company, Firm, etc.

Representative Name 1*

First Last

Representative Name 2

First Last

Are any more Representatives Needed to Be Added

Yes
No

Other Representatives

Separate Full Names with a "," or ";" ex.
Adam Anderson, Ben Brody, Catherine Coalson,
or
Adam Anderson; Ben Brody; Catherine Coalson;

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Nature of Business

Spouse(s) Name(s) if attending

Separate Full Names with a "," or ";" ex.
Adam Anderson, Ben Brody, Catherine Coalson,
or
Adam Anderson; Ben Brody; Catherine Coalson;

Number attending Sunday picnic

Section Break

Booth Registration (Includes 2 Full Conference Registrations)

Price: $550.00 Quantity:

Registration By 5/2/19 is $500, after 5/2/19 will be $550

*Full conference registration includes breakfast & lunch on Monday and Tuesday and banquet Tuesday.

Additional Representative (Exhibit Hall Only)

Price: $75.00 Quantity:

Registration By 5/2/19 is $75, after 5/2/19 will be $75

Additional Booth Space (Exhibit Table Only)

Price: $300.00 Quantity:

Registration By 5/2/19 is $300, after 5/2/19 will be $350

Spouse/Guest Banquet Ticket

Price: $35.00 Quantity:

Registration By 5/2/19 is $35, after 5/2/19 will be $40

One day lunch only - Monday

Price: $30.00 Quantity:

Registration By 5/2/19 is $30, after 5/2/19 will be $35

One day lunch only -Tuesday

Price: $30.00 Quantity:

Registration By 5/2/19 is $30, after 5/2/19 will be $35

Total for Exhibitor Hall

$0.00

I would like to donate banquet ticket(s) to Award/Scholarship winners and their guests.

Yes
No

How many banquet ticket

Price: $35.00 Quantity:

Section Break

Contact Larry Bonar at (304)845-4360 with any questions.

Do you need electrical power?

Yes
No

Floor plan preference, Table #

*Does not guarantee selection, first come, first serve basis. Layout is subject to change.

*Please review the guidelines located on page 5 of the 2018 Joint Conference Registration Packet.

Total

$0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name