2013 Summer Affiliate Registration Form

August 13-14, 2013 – Coeur d' Alene Resort, Coeur d' Alene, Idaho. Your company must be an ICTA Affiliate member to participate in the Summer Show. Additional Affiliates need to complete the Additional Affiliate Registration Form

Name*
FirstLast
Title*
Preferred Name on Badge*
Company Name*
Email*
Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Phone*
Fax
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Conference registration includes admission to all sessions, tabletop exhibit (one per company), receptions, and meals. Sponsorships of $500.00 or more will receive a $100.00 discount on one registration fee.
Tuesday Welcome Reception - maximum number of sponsors (2)
Price: $500.00 Quantity:
Wednesday Breakfast - maximum number of sponsors (3)
Price: $200.00 Quantity:
Wednesday Lunch - maximum number of sponsors (4)
Price: $200.00 Quantity:
Wednesday Reception - maximum number of sponsors (4)
Price: $200.00 Quantity:
Wednesday Dinner/Auction - maximum number of sponsors (2)
Price: $200.00 Quantity:
Affiliate Member Registration Fee - $100 of your registration fee will be donated to ICTA's PAC Fund- non tax deductible
Price: $450.00 Quantity:
Additional Affiliate Registration Fee: Please fill out a separate registration form here
Affiliate Member Registration Fee - with $500.00 & up sponsorship
Price: $350.00 Quantity:
Reserve a table
- Please reserve an exhibition table
Golfing (optional)
Price: $190.00 Quantity:
Spa Day (optional)
Price: $190.00 Quantity:
Additional Fee for Late Registration(received after July 26, 2013)
Price: $75.00 Quantity:
Will you be contributing any items for the PAC Auction?
- Yes
- No
How many items?
Additional Affiliates - $200 each (Please make sure they complete the separate Additional Affiliate Registration Form)
Price: $200.00 Quantity:
Total
$0.00

Idaho Cable Telecommunications Association

208.344.6633 | info@idahocable.com

2013 Summer Affiliate Registration Form

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