Exhibitor Registration Form
DPCA 51st ANNUAL SHORT COURSE February 15th & 16th, 2012 – Exhibitor Information

REGISTRATION - Cost for exhibiting at this 2-day meeting remains the same as last year - $300.   This
includes 8’ tables, breaks, lunches, etc.  In addition, we would like to extend an invitation to you to
contribute to the short course by helping to defray some of the speaker costs as many of you did last
year.  In return, we will provide you with substantial credit by way of advertising and acknowledgement.  
Your company’s name will appear in the front of the workbook.   For further information please call (302)
994-9101 or email admin@dpca.net.

REFUNDS – Exhibitor registrations must be received no later than January 10, 2012.  Registration may
be withdrawn from the course with a full refund less a $25 processing fee provided our office is notified by
February 01, 2012.  Due to obligations for meals and space, money cannot be refunded after February
05, 2010.  For further information please call (302)736-2668 or email admin@dpca.net


NAME                __________________________________________________________
( First )                                          ( Initial )                                          ( Last )                                 

Company:         __________________________________________________________

Address         __________________________________________________________

Phone:        _______________    Fax:  _______________    Email: ______________


                                                               # Attendees                     Total

Registration Fee                       $300                     ____1___                $___300__

Additional Reps                        $90 ea.                 ________                $________

Speaker Sponsorship              $300                     ________                $________


Speaker: __________________________________________

Workbook Advertisement         $100.00               ________                $________

                                Grand Total                ________                $________

Make check payable to DELAWARE PEST CONTROL ASSOCIATION and mail to:

DPCA
P. O. Box 411
Dover,  DE  19903-0411








----------------     Please list additional representatives below     --------------





Additional Exhibitor Reps at $90 Each

NAME
1.

2.

3.

4.

5.

TOTAL:        __________  X $90           (add to front)