14
| Rural Water Association of Arizona
Exhibit Space &
Sponsorship Application
22
nd
Annual Technical Conference
| Chandler, AZ - March 5
th
-7
th
Crowne Plaza San Marcos Golf Resort
(
Exhibit hours March 5
th
4:30
pm to 6:30pm and March 6
th
8:00
am to 12:00pm
BOOTH SPACE APPLICATION ONLY (Fill out payment section at bottom of page)
Company Name:________________________________________________________________________________________________
Address:_ ______________________________________________________________________________________________________
City: _ _________________________ State: _ _____ Zip:______________________________________________________________
Primary Contact for Exhibit Booth Information: ____________________________________________________________________
Phone: _ _______________________ Fax: _________________________ Email:____________________________________________
Associate Member Rate
$550
Non-Member Rate
$900
Booth Space = 8’x10’
1
st
Choice: _ ______________ 2
nd
Choice: _ ________________3
rd
Choice:_ _______________
A non-refundable deposit of 50% of the total cost of the exhibit space requested is required with this application and will
apply to the cost of the space assigned. Applications will not be valid without the required deposit.
Remaining balance
must be paid in full by Friday, February 15
th
, 2013.
SPONSORSHIP FORM (Fill out payment section at bottom of page)
Gold Sponsor .............................$750
Non-Member Gold Sponsor ...................$1,100
Event Sponsor ............................$250
Please specify which event you would like to sponsor:
Premium Booth Space = 8’x10’
1
st Choice:
2
nd Choice:
(
Sponsors and Exhibitors Fill Out This Section)
BOOTH ATTENDEES (first two attendees are covered in the cost of the booth; additional attendees are $50 per person
Attendee #1: __________________________ Attendee #3 (Add $50): _ ________________________
Attendee #2: __________________________ Attendee #4 (Add $50): _ ________________________
(
PAYMENT SCHEDULE & INFORMATION)
Make all checks payable to RWAA (Rural Water Association of Arizona). Payments may be made by check or by credit card. The
deposit, with this application, should be sent to:
Rural Water Association of Arizona, Attention: Bernadette Kunce, 1075 S. Idaho
Rd., Suite 213, Apache Junction, AZ 85119.
Applications received on or after February 15
th
, 2013,
must be accompanied by 100%
payment of the exhibit space cost. Deposits are non-refundable. Cancellations after February 15
th
, 2013
all balances are non-refundable.
List your company’s product(s) and/or services:_ _______________________________
List any competing company/companies from which you desire separation:__________________________________________
TOTAL PAYMENT AMOUNT: $________________________
FORM OF PAYMENT(Circle one): CHECK ENCLOSED
CREDIT CARD Type: Visa
MasterCard
Discover
American Express
Billing Address(if differs from address above)
Card Number:_ _________________________________________
_______________________________________________________
Cardholder signature:_ __________________________________
_______________________________________________________
Expires: _ _____________ Card Verification Code:_ __________
I authorize RWAA to charge my credit card in the amount listed above.
Cardholder Signature_ ________________________________________________
For Association Use Only:
Date Received _ _______________________
Paid in Full/Date _______________________