2010 NC Public Transportation Conference and Trade EXPO
Sponsor and Exhibitor/Vendor Online Registration

Please fill out the form below to complete your online registration.

* indicates a required field for form information to submit correctly.

The information below should be filled out for the primary contact:

First Name* A value is required.Last Name* A value is required.

Badge Name

Guest/Spouse Name

Your Title* A value is required.

Company* A value is required.

Address* A value is required.

City* A value is required.

State* A value is required.

Zip* A value is required.

Phone* A value is required.

Cell Phone* A value is required.

Fax* A value is required.

Web address* A value is required.

E-mail Address:* A value is required.Invalid format.Please enter your e-mail address.Please correct format.

Full Description of your company’s products:*

I am requesting registration for the following:

Annual Conference and Trade EXPO June 7-9, 2010

I will make payment by:

Check (do not click on the "add to cart" buttons, only check box beside activity)
Credit Card or other Paypal transaction (Use "add to cart" buttons AND check box.)
(Paypal account is not required to make a credit card payment through our Paypal merchant system.)

IMPORTANT:**You must click "SUBMIT" at the bottom of the page for your registration form to be sent to NCPTA- Paypal is only the payment...not your registion for the conference***

Sponsorship or Vendor/Exhibitor Fees

Platinum Sponsorship- $4000

Gold Sponsorship - $3000

Silver Sponsorship- $2000

Bronze Sponsorship- $1000

Other Sponsorship- In increments of $100 [Increase quantity on shopping cart page to meet amount]

EXPO Prize Donation #1 - $50 [Increase quantity on shopping cart page to meet number donated]
Select correct number of prize donations at $50 each:

Conference Grand Prize Donation - List donation item (min.value $200):

EXPO Prize Giveaway - $50

Closest to Pin Sponsor - $200

Longest Drive Sponsor - $200

Sponsor a Hole - $100

Basic Exhibitor Registration includes:
• One (1) full Conference Registration
• Vendor exhibit space in the ballroom area IF AVAILABLE (overflow will be on the first floor - stairwell.)
• Company Name/Product on Conference Materials and Display Board

Basic Exhibitor Registration – Member - $580

Basic Exhibitor Registration – Non-Member - $750

High Speed Internet Access - $180

Electric Access - $90

Add Additional Representatives - $200.00 each [change quantity on shopping cart to meet number of additional representatives]
+ Add 1st additional representative name:

+ Add 2nd additional representative Name:

Bus and Van Display Outside Hotel- $125 per vehicle - Outside Spaces [change quantity on shopping cart to show how many vehicles you will display]

Driver cell phone number:*

(Email this cell phone number to Amber Wagner if you do not have it now.)

Vehicle 1 Description and Size:

+ Add 2nd Vehicle space Vehicle 2 Description and Size:

+ Add 3nd Vehicle space Vehicle 3 Description and Size:

+ Add 4nd Vehicle space Vehicle 4 Description and Size:

Late Registration (after May 24)

Today's Date:

Late fee (after May 24) - $50 additional *

NCPTA Membership Option

Yes No

Fee to join NCPTA- $300 *

Golf Tournament - Sunday, June 6
Pre-Registration is required

Golf Tournament Registration - $100 each [change quantity on shopping cart to show how many golfers from your company will play]

1st Golfer Name: Score or Handicap:

+ Add 2nd Golfer Name: Score or Handicap:

+ Add 3rd Golfer Name: Score or Handicap:

+ Add 4th Golfer Name: Score or Handicap:

EXPO Game Information

For the EXPO activity there will be a game where participants will have to seek out answers to questions about the vendors and their products. If your are registering as an exhibitor, please list five questions and answers about your company, product or any additional items that you would like others to know.

1. Question and Answer 1:

2. Question and Answer 2:

3. Question and Answer 3:

4. Question and Answer 4:

5. Question and Answer 5:

Meals

Registration includes meals. Please indicate which meals you plan to attend. All attendees in one organization/registration will attend the same meals.

June 7, Monday - Breakfast Buffet Lunch

June 8, Tuesday - Continental Breakfast Buffet Awards Lunceon Riverboat Dinner
Will you have a dinner guests that are not registered? No Yes
Number of dinner guests:
Note: Guest dinner cost will be collected at conference check-in.

June 9 Wednesday - Breakfast Buffet

Do any attendees have any special dietary requirements? *

No Yes, please list who and explain what requirements:

Do any of your attendees require an ADA accommodation? *
No Yes, please list name and explain:

Your total is: IMPORTANT:**You must click "SUBMIT" at the bottom of the page for your registration form to be sent to NCPTA- Paypal is only the payment...not your registion for the conference - YOU WILL BE DIRECTED TO MAKE YOUR PAYMENT THROUGH PAYPAL IN THE NEXT SCREEN*****.

Download packet for detailed information. (opens in new window)

Please note primary contact name and "Conference" in the memo of check or money order and mail so that NCPTA will receive by April 15. Registrations received after April 15 must include a late-registration fee of $50.

Mail the confirmation email with a check or money order (payable to NCPTA) to:
NCPTA
ATTN: Keith McCoy
21 E. Main St.
Brevard, NC 28712

If this page doesn't give you a "thank you" message after you click submit, scroll UP to see if you included answers to all required fields or view to error message by field with error.