Promoting the growth and expansion of home brewing & winemaking

Wholesaler/Exhibitor Registration - 2010 Conference

This form is for MAIL-IN or FAX-IN ONLY
P. O . Box 1373, Valrico FL 33595
Fax: 813-681-5625

Please read the set up information before registering.

SUNDAY, May 23, 2010– 9:00 am - 12:00 pm

EMBASSY SUITES DOWNTOWN PORTLAND
319 SW Pine Street
Portland OR 97204
503-796-3857
Fax 503-220-0206
Phone (reservations): 1-503-796-3857

Company Name __________________________________________
Address ________________________________________________
________________________________________________

Phone No. ______________________________________
E-mail address __________________________________

Attendees (please list names individually and PRINT clearly)

____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________

Please check here ( ) if this is your first conference.

Exhibit space is approximately 10' X 10' and a 6' table will be provided, if requested.
Up to 4 exhibitors allowed. Additional exhibitors are $25.00 each.

*2010 Dues must be paid to qualify for Member rates.
Fees may be paid in US funds OR EQUIVALENT.

		No.	Total
One Table	Members: $250.00 USD Non-Members: $350.00 USD INCLUDES BUFFET LUNCH FOR ONE	___	_________
Two Tables	Members: $350.00 USD Non-Members: $450.00 USD INCLUDES BUFFET LUNCH FOR ONE	___	_________
Additional Exhibitors	$25.00 each (NO LUNCH)	___	_________
Attendance Only NOT EXHIBITING	Per person: Members: $50.00 USD Non-Members: $75.00 USD NO LUNCH	___	_________
Additional Lunches	$45.00 per person	___	________
Portland Tour	$65.00 per person	___	________
Pub Crawl - Sun. PM	This year all the pubs are with in walking distance of the hotel - no long bus rides!	___	________
Home Brew Shop Visit - Sat. PM	$20 per person (covers transportation)	___	________
	SUB-TOTAL		_________
DISCOUNT	Register by 20 April & save $25 per table		________
PAYMENT - MINIMUM 50% DEPOSIT REQ'D			_________
BALANCE DUE AT REGISTRATION			_________

Exhibit fees INCLUDE LUNCH, service charge & gratuity for one person.

NOTE: Make checks payable to FITA & mail to P.O. Box 1373, Valrico FL 33595
Or FAX this form to 813-681-5625.

REFUNDS - Full refund (less $15.00 USD processing fee) until 1 May 2009.

We take your privacy very seriously and we never sell, rent or otherwise distribute the information you submit on our website. You can rest assured that your personal information, including your email address, will be kept in strict confidence.

RETAILERS - please use retailer registration form.

Please note: 2010 dues must be paid to qualify for "Member" rates.