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
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.
Please indicate any dietary restrictions/allergies the representatives have

Vendor Registration
Vendor Registration includes:

1. 6 foot table

2. 2 chairs

3. WiFi

4.food and drink for 2 representatives

Electricity is available for an additional charge.
CTSRC 2025 Vendor Booth Fee Quantity*
Price: $1,600.00
Booth reservation cost includes one table and two vendor representatives. Additional representatives may register below.
Electricity Quantity
Price: $100.00
If you require electricity, an additional charge is required
Additional vendor options
- Third Representative
- Fourth Representative
- Fifth Representative
Additional 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.
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.
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.
Total
$0.00
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.
Payment Options
Checks must be mailed to:

CTSRC Treasurer

566 Highland Ave

Waterbury, CT 06708

Checks must be received by April 5th to secure your spot.
Comments
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:

Checks must be received by April 5th to secure your spot.