2012 OFDA Dealer Strategies Conference
Tabletop Display Reservation Form

DEPOSIT:  At least 50% of total fees due at form submission with balance due 10/1/2012.
CANCELLATION POLICY: Cancellations before 10/1/2012 will result in 50% penalty of fees paid.  Cancellations after 10/1/2012 are non-refundable.

CONTACT INFORMATION

Name: 
Title: 
Company: 
Address: 
City: 
State: 
Zip: 
Phone: 
Fax: 
Contact Email: 

TABLETOP PRICING:

OFDA Sponsor: Call for Rates
Member:  $1,500.00
Non-Member $2,000.00

DISPLAY LOCATION CHOICE:

1st   
2nd 
3rd  

PAYMENT INFORMATION:

Amount to be charged: 
Payment Method:  Credit Card      Company Check     Please Invoice Me

Credit Card Type:  AmEx    VISA     MasterCard

Name on Credit Card: 
Credit Card Number: 
Expiration Date: 

If billing address is different from above please enter information:

Address: 
City: 
State: 
Zip: