2021 EXHIBITOR REGISTRATION FORM 39th Annual South Central Joint Mine Health & Safety ConferenceMar 29 – Apr 1 ~The Hilton Anatole~ Dallas, Texas NOTE: Each 10’X10′ booth includes one draped table (optional undraped), one chair, draping between booths and back draping. All draping will be black. IF YOU PREFER A DIFFERENT ARRANGEMENT please specify below; we will notify you if there is an additional charge to accommodate your special needs:Company Name:*Company Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Person (Point of Contact):* First Last Email* Phone*Description of Company*Please provide a brief description of services and / or products the company offers as soon as possible to post to our “2020 LIST OF EXHIBITORS”. This includes website, mailing address you wish to have listed, Phone number, email address, etc FEES:Booths : $895 /each*Basic Fee includes One Participant Registration per booth (includes all meals & refreshments served by the Conference, including attending the Awards Luncheon and any sessions or workshops) Price: $895.00 Quantity: Requested Booth Numbers*Please list the booth or booth numbers requestedAdditional Participant: $375 each(includes additional chair in the booth, all meals & refreshments served, and attending the Awards Luncheon and any sessions or workshops) Price: $375.00 Quantity: There are 48 booths available first come first served. All booths are priced at $895.00 Please see Exhibitor Services form for details on other services offered. Use online form for booth fees, Exhibitor service is separate. Cancellation Policy: NO REFUNDS after Feburary 28, 2019 Booths must be PAID IN FULL to be added to our website Exhibitor Hall Diagram REQUIRED FOR NAME BADGES:Name & Title of each AttendeeCard Billing InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Total Due $0.00 EmailThis field is for validation purposes and should be left unchanged. Have questions? Contact Us