Minnesota Council of Teachers of Mathmatics

Minnesota Council of Teachers of Mathematics
2011 Fall Conference Exhibit Registration Form
Exhibitor registration deadline is Friday, October 7, 2011. You may also print and mail to MCTM, PO Box 289, Wayzata, MN 55391. If you have any questions, please contact Tom Muchlinski by email at tmuchlinski@earthlink.net.

Company Name:
Representative Name:
Address:
City / State / Zip:
Email:
Phone:

FALL CONFERENCE EXHIBITOR FEES
Initial Table Fee	Includes conference participation, one 6-foot table and one lunch ticket		$150
Additional Tables	Cost per Table: $100	Additional Tables Requested:	Additional Tables Fee:
Additional Lunch Tickets	Cost per Lunch: $15	Additional Lunches Requested:	Additional Lunches Fee:
Donation for Coffee/Rolls (optional)	Your company’s optional donation for coffee and rolls will be acknowledged at the conference		Donation Amount:
Full Payment is Required with Reservation		Total Amount Due:
OTHER ITEMS
Number of electrical outlets requested (Please note the number of outlets is limited and exhibitors must supply extension cords)
Number of door prizes you are able to donate (Please note the donation of door prizes is optional)
Total number of chairs needed by your tables
Other special needs (Internet access may be available)
Additional information will be sent with the confirmation letter.

METHOD OF PAYMENT
Credit Card PLEASE NOTE: You will be prompted to pay via PayPal after this form has been submitted. The PayPal form will say "donation", but it IS your conference fee payment) Check payable to MCTM PO Number If using a P.O., please send a copy either via surface mail or as an email attachment to tmuchlinski@earthlink.net. Mail checks and P.O.s to: MCTM PO Box 289 Wayzata, MN 55391	Questions concerning payment or billing can be directed to: Tom Muchlinski - MCTM Executive Director Phone - 612-210-8428 Email - tmuchlinski@earthlink.net