Registration Form
Organization Name _________________________________________________
(As it should appear in promotional material)
Mailing Address ______________________________________________
______________________________________________
_____________________________________________
Phone _____________________________ Fax______________________
Email _________________________________
o Booth Fee - For Profit Organization/Business $35
o Booth Fee - Non Profit Organization With Items for Sale $35
o Booth Fee - Non Profit Organization - Table with Skirt $20
o Booth Fee - Non Profit Organization - Table Only $10
Amount remitted _____
Name Tag Request (if desired) (list individuals working at the booth)
______________________________ ____________________________
______________________________ ____________________________
______________________________ ____________________________
Tables Are 8' Long. Set Up Can Begin After 2:00 Pm On October 16
Disclaimer of liability (please read carefully and sign below)
I, the exhibitor in the High Country Conservation Expo 2003_____________________do
hereby agree to hold harmless and release the MountainKeepers and Broyhill Inn
and Conference Center from all liability for any loss or injury to myself, my
employees or my property.
I hereby agree to assume responsibility for any loss or injury to myself, my
employees or my property while on the grounds of the exhibition. I agree to
furnish surge protectors for computer equipment in my booth and to furnish grounded
industrial strength extension cords for any electrical use in my booth.
Authorized signature______________________________________________________________________
Mailed completed form and check to: MountainKeepers
P.O. Box 21 DTS
Boone, NC 28607
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