Capital & Northern Region Self-Advocacy Conference

Capital & Northern Region Self-Advocacy Conference

June 13, 2006 9-3:30

Queensbury Hotel, Glens Falls, NY

Vendor Registration Form

Information tables are available for the Capital & Northern Region Self-Advocacy conference. A table is provided, with tablecloth and chairs for the number registered. All vendors must register. Table set-up begins at 8:15am

Arts and Crafts table: Self-advocates Cost: Free ¨

Information table: Not-for-profit Cost: $25 ¨

Information table: Government or For-Profit Cost: $50 ¨

Information table with electricity: Cost: $75 ¨

Number of people attending:___ X $20 = Cost: $____

Total: $______

Registration: Please list contact name first. Contact Phone:______

Name:______Title:______

Name:______Title: ______

Name:______Title: ______

Name:______Title: ______

Company or Organization:______

Address: ______

______

Capital District DSO, 500 Balltown Road, Schenectady, NY 12304 Tel: 518-382-1454 Fax: 518-382-1459

Email: www.sanys.org