NBCSN Liaison Request for Support at State Conference

Please complete ALL information to process request.

All conference material will be mailed to you prior to conference (subject to availability). Request must be received no later than one month before conference. All information MUST be filled in.

After the conference, you must return the display, brochures, ribbons and booth attendee list, within 48 hours of the completion of the conference. Instructions for return and a mailing label will be included.

Name: *This question is required.

Address: *This question is required.

City: *This question is required.

State: *This question is required.

ZIP: *This question is required.

Phone (H): *This question is required.

Phone (W): *This question is required.

Email: *This question is required. This question requires a valid email address.

Expected Conference Attendance: *This question is required. This question requires a valid number format.

Location of Conference: *This question is required.

Date of Conference *This question is required.

Materials:

Vendor fee for Exhibit Area Display (Up to $150 will be paid by NBCSN. Attach Vendor Application. Check will be mailed to State or Conference Treasurer)
$100 Honorarium (Will be paid upon receipt of: a completed State Conference Sign Up Sheet, a copy of your attendance certificate, your unused materials and display).
NBCSN Display
NBCSN Ribbons
NBCSN Liaison Ribbons

1. Please attach completed vendor application.

File: {{filename}} delete

1. Vendor Fee for Display Amount:

1. NBCSN Display Materials — Please rank in order of preference. We will try to accommodate all requests: Order the items from the following list. First select an item with the spacebar to show a menu of possible ranking positions. Next, click a ranking position to order it in the ranked list. Note the menu will display more ordering options as you add items to the ranked list.

Table Top
Floor Banner
Table Banner

1. Number of NBCSN Ribbons:

1. Number of NBCSN Liaison Ribbons:

Number of NBCSN Certification Brochures *This question is required. This question requires a valid number format.

Number of NBCSN Recertification Brochures *This question is required. This question requires a valid number format.