LACC Exhibitor Registration

* Required

CONTACT INFORMATION
First Name*
Last Name*
Company*
City*
State/Province*
Country*
Phone*
Email Address*
Confirm Email Address*
STAFF INFORMATION
Please enter the staff names to receive badges (Do not enter name from above): *
Exhibitor badges are limited to four (4) badges per 10 x 10 booth. There is a $50 charge for additional badges.
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OTHER INFORMATION
YES
NO
I would like to receive advertising material from MMPI, including information about other MMPI events or special offers, by:
Phone
Fax
Email
Regular Mail
 
I would like MMPI to share my contact information with trusted third parties in whose products or services MMPI believes I may be interested, and understand that these unaffiliated third parties may send me advertising material by phone, fax, email, or regular mail.
 
I understand that by providing this information and making these choices, MMPI will use my information in compliance with its Privacy Policy, and that notwithstanding any of my selections above, by providing this information I hereby consent to allow MMPI to use my information to contact me by phone, fax, mail or email about MMPI services or events related to the event or service for which I am registering. To verify consent, click the Accept button: