ATIA 2009 Chicago Conference Exhibitor and Member
CONFERENCE DATES: OCTOBER 28 – 31, 2009
EXHIBIT DATES: October 29-31, 2009 
Renaissance Schaumburg Hotel & Convention Center Schaumburg (Chicago), IL


Organization Name________________________________________________________________________________							
Company Address__________________________________________________________________________________

														
City_____________________State/Province_____________Zip/Postal Code____________ Country__________

														
Contact Name_____________________________________________________________________________________ 
(This person if attending the show must also be listed below under "Registration Names")

														
Telephone____________________________	Fax____________________________	Email____________________

														
Booth Number_____________		Total Square Feet__________________
	
Please Check your current ATIA Membership Status:
_____Member  			$100.00 each
_____Non-Member			$175.00 each
_____Member – Not exhibiting	$175.00 each

IMPORTANT!
		
For every 10’ x 10’ booth unit of exhibit space, each Exhibiting Company receives:
 - Two (2) complimentary exhibitor badges 

For every non-profit 10’ x 10’ booth unit of exhibit space, each Exhibiting Company receives:
 - One (1) complimentary exhibitor badges

PAYMENT INFORMATION:	

PAYMENT BY CHECK - 
Make checks payable to ATIA.

Enclosed is my check for $__________________ 	
(Must be in U.S. dollars & drawn from a U.S. bank.)

Mail to:
ATIA Headquarters		Fax to: 				Email:				
1325 Paysphere Circle	or	(Credit Card payments only)	or	registration@atia.org
				(312) 673-6939					
			 		
Chicago, IL 60674								 	

PAYMENTS BY CREDIT CARD -  
Charge $______ to my credit card:(circle card type below) 	 

	Visa	  		MasterCard			American Express

Card Number:____________________________________________________ 	
							
Expiration Date:________________			 

Name as it appears on card:_____________________________________										
Signature:______________________________________________________													

Registrant Name(s): 
PLEASE PRINT and PROVIDE INDIVIDUAL EMAIL ADDRESS. 
If email address is not given, all confirmation emails will be sent to contact email listed above.

Complimentary Exhibitor Registration Code _______________

1.___________________________________________________________________________	$__________________		
  Name						Individual Email Address	 Fee if Appropriate

2.___________________________________________________________________________	$__________________		
  Name						Individual Email Address	 Fee if Appropriate

3.___________________________________________________________________________	$__________________		
  Name						Individual Email Address	 Fee if Appropriate

4.___________________________________________________________________________	$__________________		
  Name						Individual Email Address	 Fee if Appropriate

CONTINUE REGISTERING ADDITIONAL INDIVIDUALS ON SEPARATE PAGE.