2019 Conference Exhibitors Registration – ONLINE PAYMENT Use the form below to register and pay ONLINE with credit card or paypal. Did you know? You can request to become a Corporate Sponsor and receive complimentary or discounted exhibitor space, priority exhibit location selection, and other benefits. Learn about Corporate Sponsorship REGISTRANT INFORMATIONName of Company*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Contact Person* First Last Title*Attach Business CardAccepted file types: gif, jpg, png, pdf.Phone Number*Cell NumberFax NumberEmail Address* BOOTH PREFERENCESBooth registration includes Saturday and Sunday lunch. Award Banquet tickets can be purchased below.Please specify your booth needs*Please selectOne booth spaceTwo booth spacesThree booth spacesNumber of tables1 tableNo tablesNumber of tables1 table2 tablesNo tablesNumber of tables1 table2 tables3 tablesNo tablesElectrical Needs*Please selectNon ElectricalElectricalOne Booth Space | Non Electrical Price: $ 1,150.00 CAD On or before July 31, 2019One Booth Space | Electrical Price: $ 1,300.00 CAD On or before July 31, 2019Two Booth Spaces | Non Electrical Price: $ 2,200.00 CAD On of before July 31, 2019Two Booth Spaces | Electrical Price: $ 2,500.00 CAD On or before July 31, 2019Three Booth Spaces | Non Electrical Price: $ 3,250.00 CAD On of before July 31, 2019Three Booth Spaces | Electrical Price: $ 3,700.00 CAD On or before July 31, 2019Wattage1500 Watts800 WattsAWARD BANQUETAward Banquet tickets Price: $ 71.43 CAD Quantity: TOTAL AND PAYMENTAfter reviewing your total, please click the button below. You will be directed to Paypal where you can pay by credit card or your Paypal account.13% HST* Price: $ 0.00 CAD (HST# 865266308 RC 0001)TOTAL $ 0.00 CAD Acceptance of Agreement* I agree Any changes requested after August 30th, 2019 will cost an additional $ 500.00. Participants by virtue of attending the MDRAO Conference, give their permission and consent to the Directors of the MDRAO to use their images or photographs or appear in videos or any other electronic or print media for advertising, news coverage, or any other commercial use of our event. I warrant that the information I have provided on this form is correct, and my acceptance and expected compliance to this agreement. This iframe contains the logic required to handle Ajax powered Gravity Forms.