Vendor Registration Form

Vendor Form

Step 1 of 2

Contact Information
Company Name*
Contact Person*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Enter Email Confirm Email

Please provide a method to contact you. A confirmation email will be sent. Duplicate email addresses are not accepted.
Phone*
List the names of the two company representatives attending. Any additional representative may register on the payment page.
Representative*
First Last Credentials
AARC Number
If your representative is an AARC member and is requesting CRCE credit, please provide their AARC membership number.
Phone
Please indicate a number that we may reach you during the conference if we need to.
Representative
First Last Credentials
AARC Number
If your representative is an AARC member and is requesting CRCE credit, please provide their AARC membership number.
Phone
Please indicate a number that we may reach you during the conference if we need to.
Vendor Welcome Reception*
Will you be attending the Vendor Welcome Reception on August 31st at 7 pm?
- Yes
- No

Vendor Registration
Vendor Registration includes:

1. 8 x 6 draped booth

2. 2 chairs

3. one electrical outlet (110 volts)

4. continental breakfast and lunch for 2 representatives

Wireless internet access is available for an additional charge. Please contact the Hartford Marriott Downtown directly for more information.,/p>
Vendor Booth Quantity*
Price: $825.00
Booth reservation cost includes one table and two vendor representatives. Additional representatives may register below.
Additional vendor options
- Additional Booth Space
- Third Representative
- Four Representative
- Speaker Sponsorship
- Breakfast or Break Sponsorship
- Corporate Sponsor
Corporate Sponsor Code*

If you are a 2020 Corporate Sponsor, please enter the code you were given so that your booth space will be at no cost.
An additional booth comes with space for 2 more representatives. Please provide their names in the space below.
Representative
First Last Credentials
AARC Number
If your representative is an AARC member and is requesting CRCE credit, please provide their AARC membership number.
Representative
First Last Credentials
AARC Number
If your representative is an AARC member and is requesting CRCE credit, please provide their AARC membership number.
Representative
First Last Credentials
AARC Number
If your representative is an AARC member and is requesting CRCE credit, please provide their AARC membership number.
Phone
Please indicate a number that we may reach you during the conference if we need to.
Representative
First Last Credentials
AARC Number
If your representative is an AARC member and is requesting CRCE credit, please provide their AARC membership number.
Phone
Please indicate a number that we may reach you during the conference if we need to.
Please contact Marjorie Cullian at marjorie.cullinan@gmail.com for sponsorship options and costs. Signage for breakfast or break sponsorships will be placed near the food and beverages, and an announcement will be made to the attendees thanking the vendor for the additional support.
Signage speaker sponsorships will appear on the website and all printed materials, and an announcement will be made to the attendees thanking the vendor for the additional support.
Speaker you are sponsoring

Please indicate which speaker/topic you are willing to sponsor.
Total
$0.00
Payment Options
When you click Payment, you will be directed to the PayPal site to complete your transaction. Payment can be made using a Credit Card or a PayPal account.
Check payment Please make checks payable to CTSRC. Checks must be received by April 23, 2019.
Checks must be mailed to:

CTSRC

c/o Maureen Parmelee

90 Creamery Rd

Durham, CT 06422
Email
This field is for validation purposes and should be left unchanged.

Vendor Form

Step 1 of 2

Contact Information

Vendor Registration

Checks must be mailed to:

CTSRC c/o Maureen Parmelee 90 Creamery Rd Durham, CT 06422

CTSRC

c/o Maureen Parmelee

90 Creamery Rd

Durham, CT 06422