Great Lakes Automation Day Exhibitor Form

Exhibitor Form

Please note: prime exhibit locations are reserved for sponsoring companies.
For more information, click here.

Contact Person

Company

Tabletop Exhibit Space
(6-foot display area) Includes up to three attendees (exhibitors) at no charge.

$285

Please list the names of persons (exhibitors) attending event.
Each additional attendee over three must pay $90 to attend.

Complimentary
Attendee 1

Complimentary
Attendee 2

Complimentary
Attendee 3

Additional
Attendee 1
@ $90

Additional
Attendee 2
@ $90

Additional
Attendee 3
@ $90

Address

City

Phone

Product Names

State Zip

Additional Items: Please provide me with ...

Wireless
No Charge

Electrical Outlet
No Charge

Total

Comments:

Please charge my:	Visa MasterCard American Express Discover
Card Number
Name on Card
Expiration date

You may register in one of two ways:

1. over MAIA's secure server.

2. Print this form out and fax or mail it to MAIA, P.O. Box 80620, Lansing, MI 48908-0620

If you have any questions, please contact Wayne Joubert at (517) 323-9473, email: wjoubert@michagent.org or Jennifer Burnett at same number, email: jburnett@michagent.org.