2022 EXHIBITOR REGISTRATION FORM

Annual South Central Joint Mine Health & Safety Conference
The Hilton Anatole~ Dallas, Texas
April 18 – 21, 2022

NOTE: Each TABLE TOP booth includes one draped table (optional undraped), one chair, 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 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 “2023 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
Requested Booth Numbers*

Please list the booth or booth numbers requested
Additional 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
There are 30 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.

Booths must be PAID IN FULL to be added to our website Exhibitor Hall Diagram
By registering for the conference, you understand photographs will be taken and used on our website.
REQUIRED FOR NAME BADGES:
Name & Title of each Attendee
Card Billing Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Total Due
$0.00
Credit Card
Card Details
Cardholder Name
Name
This field is for validation purposes and should be left unchanged.

2022 EXHIBITOR REGISTRATION FORM

FEES:

Card Billing Information

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