STEMapalooza
Booth Request Form
October 24-25, 2008
Denver, Colorado
Contact Information
Organization/Company Name
*
Contact Name
*
Street Address
*
City
*
State/Province
*
Zip/Postal Code
*
Daytime Phone
*
Fax
*
Organization Website
E-mail Address
*
Confirm E-mail Address
*
Reserve Your 10' x 10' booth
Non-Corporate Partner
(Nonprofit, Government Agency, Educational Institution, NGO)
Standard $100
Corner $250
Premium $500
n/a
Corporate Partners
Small Business: <50 Employees
Standard $200
Corner $450
Premium $750
n/a
Large Business: > 50 Employees
Standard $750
Corner $1050
Premium $1750
n/a
Number of Booths
*
1
2
3
4
Description of Exhibit
Please provide a short description of how your exhibit will be activity-based
*
Referred by:(if applicable)
Payment Amount Summary
Total Amount Due (Booth fee):
Provide Payment Information
Method of Payment
*
Check (option 1)
Credit Card (Option 2)
Option 1
Check No.
Make check payable to: University of Colorado Denver
mail to:
University of Colorado Denver
STEMapalooza
Campus Box 153
P.O. Box 173364
Denver, CO 80217-3364
Option 2
Credit Card Information
Credit Card
Visa
MasterCard
American Express; no DISCOVER Cards
Credit Card No.
Expiration Date
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
3 Digit Security Code
Credit Card Billing Address:
First Name (as it appears on the card)
Last Name (as it appears on the card)
Street Address:
City:
State/Province
Zip/Postal Code
Please read the Exhibitor Terms and Conditions
*
I have read and agree to the exhibitor terms and conditions