EXHIBITION SPACE REGISTRATION FORM

The 21st Annual International Conference on Soils, Sediments, Water, and Energy, March14-17, 2011
Mission Valley Marriott, San Diego, CA
ON-LINE REGISTRATION IS AVAILABLE AT www.aehsfoundation.org

1. PLEASE PRINT OR TYPE THE FOLLOWING INFORMATION, AS YOU WOULD LIKE IT TO APPEAR ON
CONFERENCE LITERATURE AND BOOTH SIGNAGE:
Company Name (exactly how it is to appear on booth signage)____________________________________________________

Address _______________________________________________________________________________________________

City_____________________________________________________ State _________________ Zip_____________________

Contact Person____________________________________________________ Title__________________________________

Telephone ________________________________________________ Fax__________________________________________

Contact Email ________________________________________________URL_______________________________________

General Email (to include in directory)

2. PLEASE PROVIDE A COMPANY DESCRIPTION. THIS INFORMATION WILL BE PRINTED IN THE

EXHIBITOR DIRECTORY may send by email (preferred) to Brenna@aehsfoundation.org

3. FEES (includes 110v electrical outlet):

_______ 8’ X 10’ or 6’ X 10’Booth space @ $1395.00 (as selected – layout will be emailed to you)

_______ Supporter* Booth space @ $695.00

_______ Sponsor* Booth space @ No Charge

_______ Special Session Sponsor* Booth space @ No Charge

*If your company is interested in becoming a Supporter, Sponsor, or Special Session Sponsor of the West Coast Conference,
please contact Brenna Lockwood at 413-549-5170, brenna@aehsfoundation.org or visit our website, www.aehsfoundation.org

4. PLEASE LIST NAME (and affiliation if different from above) OF PERSONS ATTENDING AS BOOTH STAFF:

5. LUNCH OPTION: lunches are not included with the booth package and must be purchased separately. Luncheons are $32.25
per person and may be purchased on site at the conference.

6. PAYMENT INFORMATION (check or credit card accepted)

Payment by check (checks payable to AEHS Foundation) FIN # 262624347

Visa MasterCard American Express Discover

Card Number Expiration Date

Cardholder Name_________________________________________________________Date________________________________

FAX OR MAIL FORM TO: AEHS Foundation, Brenna Lockwood, 150 Fearing Street, Suite 21, Amherst, MA 01002  Telephone: (413) 549-5170  Fax:
(413) 549-0579
CANCELLATION POLICY: Cancellations received in writing on or before January 31st will receive a full refund minus $100 processing fee. Refunds will not be
issued for booth spaces cancelled after January 31st.