OIADA FALL 2022 Conference

Registration Information

First Name *

Middle Name

Last Name *

Company *

Street Address *

City *

State *

Zip Code *

Phone

Cell Phone

Email *

If you are donating a sponsorship item please list item and $ value

Event Fee(s)

Event Fee *

Member rate - $ 70.00

Non-members - $ 85.00

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Below are optional sponsorship options for this event

Trade show booth

Sponsor trade show booth - $ 400.00

Sponsor a lunch (3 available)

Sponsor a lunch - $ 300.00

Sponsor a beverage service

Sponsor a beverage service - $ 150.00

Total

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *