VENDOR REGISTRATION (Print & Mail Form)
MDIAI Annual Educational Conference
Vendor Registration Form
Company Name___________________________________________________________
Address_____________________________________ State____________Zip_______
Contact Person_____________________________________________________________
Phone (___)_______________ Fax(___)_____________ E-Mail_________________
Display synopsis____________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Vendor Fee $250 (includes Hotel Vendor Fee)
Please circle one: (1)Prepay by Check (enclosed) (2) Pay at Conference by Check or Cash
Please submit completed form to: MDIAI Secretary-Treasurer Jennifer Jaspersen
6925 75th Ave No, Brooklyn Park, MN 55428
Vendor Registration Form
Company Name___________________________________________________________
Address_____________________________________ State____________Zip_______
Contact Person_____________________________________________________________
Phone (___)_______________ Fax(___)_____________ E-Mail_________________
Display synopsis____________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Vendor Fee $250 (includes Hotel Vendor Fee)
Please circle one: (1)Prepay by Check (enclosed) (2) Pay at Conference by Check or Cash
Please submit completed form to: MDIAI Secretary-Treasurer Jennifer Jaspersen
6925 75th Ave No, Brooklyn Park, MN 55428