Exhibitor Registration

Booth(s) at $250 each

Electrical Hookup at $25 each

Vehicle(2) at $500 each

Total Cost

Product or Service Description

Business/Organization Name.
.

Primary Representative
.

Title

eMail

Business Phone ---- ( ) ....

Address 1 1

Address 2 1

City.......

State .. Zip Code

Additional Representative

Additional Representative

Payment by Paypal below or Checks payable to:

KC Mutual Aide/EXPO
P.O. Box 907
Charleston, WV 25323

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