b'EXHIBITOR BOOTH REGISTRATIONMRCA News MIDWEST ROOFING CONTRACTORS ASSOCIATION 73rd Annual Conference & ExpoOctober 18-20, 2023CHI Health Convention Center - Omaha, NECOMPANY INFORMATION:EXHIBIT FEES: This Representative will be contacted for all program details, finalizing ofMember RateNon-Member Rate booth personnel and for decorator/electrical needs. Please print or type.10x10 Booth$2,000 each $2,500 eachCompany Name for Billing Purposes:4 or more booths$1,825 each $2,325 each___________________________________________________________Number of Booths______________ x rate per booth ________________ Company name as you wish it to appear on Signage and in Printed Materials:= Total $ _________________% Being Paid Today: _______________ ___________________________________________________________Preferred Booth Numbers: Address: ___________________________________________________1st Choice: ____________ 2nd Choice: ____________City, State, Zip: ______________________________________________ 3rd Choice: ____________ 4th Choice:____________ Office: _______________________ Cell: __________________________ Please list companies that you prefer not to be near: Email: _________________________________________________________________________________________________________________ Website: ____________________________________________________BILLING INFORMATION: Full Name: __________________________________________________ READ BEFORE SIGNING: Exhibitors signature on this contract indicatesFull Name: ______________________________ Title: _______________ acceptance of the Rules and Regulations provided with this contract and isCompany Name: _____________________________________________ an agreement to pay the total amount due. The person signing this contractIF DIFFERENT FROM ABOVE: on behalf of the exhibitor has the authority to do so and is responsible for employees adherence to the Rules and Regulations.Address: ___________________________________________________ Signature: __________________________________________________ Company and/or Product Description (Will be included on MRCACity, State, Zip: ______________________________________________ Website & Expo Mobile App ( Can also be emailed to rpinkus@mrca.org)Country: ____________________________________________________ ___________________________________________________________ PH: __________________________ FX: __________________________ ______________________________________________________________________________________________________________________ Email: ______________________________________________________ ______________________________________________________________________________________________________________________ Please make checks payable to Midwest Roofing Contractors Association ___________________________________________________________ and send check along with this completed agreement to: ___________________________________________________________ Attn: Carroll Hamann___________________________________________________________MRCA Exhibits PAYMENT INFORMATION:7250 Poe Ave. Ste. 410 Dayton, Ohio 45414 Applications will be accepted as long as space is available. A signedYou may also send your completed agreement to: contract is considered an agreement to pay the total amount due. Tochamann@mrca.org orFax: 937-278-0317qualify for the Member Rate, the exhibiting firm needs to be an activemember in good standing at the time of conference. If membership duesCredit Card Payment Information: are not current, you will be billed at the higher rate. Payment Schedule: 25% of the booth fee is due with the Exhibitor CC#: _______________________________CVV_____Exp. Date ______ Contractif submitted before March 31, 2023. 50% of the booth fee must be Name on Card: ______________________________________________ submitted by June 30th and 100% is due by September 15th. Booth spacemust be paid in full before being permitted to set-up exhibit.Billing Zip Code: _________________ Amount Being Charged: $_______ Space Cancellation: The space cancellation deadline is September 15, 2023, after which no refund will be made. QUESTIONS? Contact Rachel Pinkus or Carroll Hamann at 800-497-6722 rpinkus@mrca.org ORchamann@mrca.org 18 www.mrca.orgMidwest Roofer'