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 AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe 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, and 1 Awards Banquet Ticket. Additional Awards Banquet tickets can be purchased below.Please specify your booth needsPlease selectOne booth spaceTwo booth spacesThree booth spacesNumber of tables1 tableNo tablesNumber of tables1 table2 tablesNo tablesNumber of tables1 table2 tables3 tablesNo tablesElectrical NeedsPlease 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 WattsBOOTH REPRESENTATIVESYou are allowed two representatives for each booth you purchase. Tickets for additional booth reps may be purchased below at $50 each.Your selection of one booth includes two booth representatives to manage your exhibit free of charge. Your selection of two booths includes four booth representatives to manage your exhibit free of charge.Your selection of three booths includes six booth representatives to manage your exhibit free of charge.Additional Booth Reps Price: $ 50.00 CAD Quantity: Please enter the names of your Booth RepsFirst NameLast Name Click the "+" sign to add a new name.AWARDS BANQUETAwards Banquet tickets Price: $ 71.43 CAD Quantity: Coupon Code If you were provided with a coupon code, please enter it here. 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.Subtotal $ 0.00 CAD Tax: 13% HST $ 0.00 CAD (HST# 86526 6308 RT 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.