Issue link: http://psai.uberflip.com/i/857947
My check is enclosed OR please charge total amount to: ___ VISA ___ MASTERCARD ___ AMEX Cardholder Signature: _________________________________________________________________________________ Cardholder Name (Please Print): ________________________________________________________________________ Card Number: ______________________________________________ Exp. Date: ________________ CSC: __________ Disclaimer: PSAI reserves the right, without liability, to reject, omit or exclude any advertisement for any reason at any time, whether or not such advertise- ment was previously acknowledged, accepted, or published. Advertiser/agency shall not submit advertising to PSAI that is discriminatory because of sex, race, religion, color, national origin, sexual orientation, gender identity, age, physical handicap or other improper basis, or advertising that contains derogatory comments about the advertiser's competitors or about the competitor's organization, products, systems or services. Advertiser is responsible for securing the rights to publish images included in ads submitted. 2017 Nuts and Bolts Educational Conference EXHIBITOR REQUEST FORM TABLE TOP DISPLAY TOTAL $_______________ 13 $_______________ $_______________ EVENT MAILER TOTAL SPONSORSHIP TOTAL Company Name: __________________________________________________________________________ Address: _________________________________________________________________________________ City: _____________________________ State/Province: ____________ Zip/Postal Code: _____________ Company Email: ___________________________________ Company Phone:________________________ Total Amount Due: ___________________ *Please call the PSAI office if you need assistance determining your total PORTABLE SANITATION ASSOCIATION INTERNATIONAL 2626 E 82nd Street, Suite 175, Bloomington, MN 55425 USA Phone: 952-854-8300 Fax: 952-854-7560 info@psai.org