HPC - Exhibitor Registration

HPC - Exhibitor Registration

Contact Information

Contact Name*

Contact Email*

Contact Phone Number*

Phone

Allow Text Messages

Select

Organization

Name of Organization

Type of Institution

Programs and/or Degrees Offered

Name of Representative 1

Name of Representative 2

Number of Additional Representatives

First two representatives are included. Additional representatives are $35 each.

Additional Representative Names

Exhibit Space

Number of Tables*

Number of Chairs*

Do you need Electric Power*

Select

Do you need Water Hookup?*

Select

Special Accommodations or Requests?

Ad Placement

Do you wish to place an Ad?

Artwork can be provided by using the file upload or emailing Dr. Carmen E. Rexach at crexach@mtsac.edu

For payment, make checks payable to

Mt SAC Caduceus Club.

Place a Half Page Advertisement?

Half Page Ad is Free, printed in Black and White

Select

Place a Full Page Color Advertisement

Full page color ads are $150.

Select

File Upload

Drag and drop files here or

Request a COPY of this Submission

If you have any additional questions or concerns, please contact Dr. Carmen E. Rexach, Mt San Antonio College, 1100 N Grand Ave., Walnut, CA 91789-1399, or by e-mail to crexach@mtsac.edu, 909-274-4223

Send me a copy of my responses

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