Affiliate Registration Form | Idaho Cable Telecommunications Association

Affiliate Registration Form

2013 Winter Affiliate Registration Form

January 22, 2013

Please complete a separate form for EACH individual registrant. Click here to complete the individual registrations

Grove Hotel Boise, ID
For Room Reservations Call: 1-888-961-5000

Name*
FirstLast
Preferred Name on Badge*
Company Name
Phone
Email
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Event Sponsorship
- Reception Sponsor ($400)
- Dinner Sponsor ($500)
Registration Fees*
- Exhibit table, social, and dinner (with Sponsorship) - $150
- Exhibit table, social, and dinner without sponsorship - $250
Premium Items
- I will be contributing premium item(s)
Do you have a guest ($50 for a guest)?
- Yes
- No
Name of Guest
Total
$0.00