SLIDE 2 PRESENTATION STAGE APPLICATION
Las Vegas Convention Center Las Vegas, NV May 30 – June 1, 2013
APPLICATION DEADLINE: April 19, 2013
- I. Sponsor / Billing Information
Please provide the information for the official contact person from your organization who is authorizing a presentation at Life@50+. Please print.
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EXHIBITOR NAME
______________________________________________________________________________________
BILLING NAME (If different than Exhibitor Name)
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BILLING ADDRESS
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BILLING ADDRESS (BUILDING, SUITE, ROOM NUMBER)
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BILLING CITY, STATE, COUNTRY, ZIP CODE + 4
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CONTACT TELEPHONE (AREA CODE, DIRECT LINE AND/OR EXTENSION) FAX
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EMAIL WEBSITE
If more than one speaker, please list in IV “Section 2” of this application. Please include speaker contact information for multiple speakers on a separate piece of paper as needed.
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SPEAKER’S NAME
COMPANY/ORGANIZATION
______________________________________________________________________________________
ADDRESS (BUILDING, SUITE, ROOM NUMBER)
______________________________________________________________________________________
CITY, STATE, COUNTRY, ZIP CODE + 4
______________________________________________________________________________________
TELEPHONE (AREA CODE, DIRECT LINE AND/OR EXTENSION) FAX
______________________________________________________________________________________
CELL PHONE E-MAIL
(Indicate your preference in numerical order – 1st, 2nd, and 3rd choice): FRIDAY, May 31 SATURDAY, June 1 AM: ___________________ AM: ___________________ PM: ___________________ PM: ___________________