Vendors & Sponsors Registration Form

I would like to be a...*

Sponsorship Level*

Company Name*

As it will appear on conference materials

Website*

What services or products do you want to showcase at the conference?*

Point of Contact

All information will be sent to this person

Name*

First Last

Title*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Is this person also responsible for billing?*

All billing information and questions will be sent to this person

Name*

First Last

Title*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Payment must be received on or before May 15, 2019

Total

$0.00

Payment method you prefer*

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Authorization*

By checking this box, the individual completing this form represents and warrants that he/she is duly authorized to execute this binding agreement on behalf of named sponsor and thus authorizes the International Narcotics Interdiction Association (INIA) to reserve sponsorship for use by the above company or organization during the International Narcotics Interdiction Association (INIA) 2019 National Conference in Miami, Florida.

Please make checks payable to INIA ($U.S.). Mail to: INIA, PO Box 1757 Spring Hill, TN 37174.