Vendor Registration

Seattle Washington 2009

 

The way this works - Fill out this form and when you click on the "submit button" on the bottom
it will send your information to  Frances Perdue R. EEG T. neurotest@hotmail.com
then a new page will open and give you 2 options of payment.

  1. You will get an address to "snail mail" your payment
    or

  2. You will have the option to "pay online" with PayPal

Any questions can be sent to Frances Perdue R.EEG T. neurotest@hotmail.com 

Company Name     

Company Address   

Company City             State:        Zip:         

Company Phone Number     Company Fax Number

 

Our Website is our main source of communication with our members. It is updated as changes occur and includes Calendar of Events, Meeting information, Technical tips, Businesses, Societies, Job postings and much more. PLEASE INCLUDE YOUR EMAIL ADDRESS

 

 Business Contact  E-mail Address    

 

Website Address   

 

Contact Person: (Will not be published on Website)  

 

Contact Phone number (Not published on website)

 

      Paying by PayPal    Sending Payment USPS      Other   Comments

 

    $850.00 Registration      $50.00 Late fee            Additional Associates Attending  (_______)

 

 Other  

 

Please make sure all information is correct before you hit submit

Once you click on the submit button you will see a confirmation page with payment options.

Thank you for your support.