The National Federation

of the Blind

2011National Convention

Exhibitor Application Form

Organization: ______

Address: ______City: ______

State/Region: ______Zip Code: ______Country: ______

Telephone: ______Fax: ______

E-mail: ______

Person(s) Responsible For Exhibit at Convention: ______

Person to Receive Letter Confirming Receipt of this Application: ______

Product/Service to be Exhibited: ______

______

List quantity and total cost for each of the following items:

______Tables at $950 each = $ ______

______Electrical Service Request* at $225.00 each = $ ______

Please check if you require either telephone or Internet access. If checked, we will authorize the hotel to provide information on cost to your organization. Please do not send any money to the NFB for these services.

*Standard electrical outlet: AC, 120 Volt circuit, 2,000 watt maximum. If your electrical needs cannot be met with the above service, contact the Exhibit Coordinator prior to the convention to order additional service. Within limits of safety and fire regulations, we recommend bringing at least one power strip to be used with each circuit ordered. Please include payment for the service requested with your payment for space.

All applications must be accompanied by the exhibitor's fee and need to be received by Friday, May 27 (we will accept written purchase orders from federal agencies).Please note that a 3% convenience fee will be added to all payments made by credit card. By return letter we will acknowledge receipt of your application and payment and provide some additional details (e.g. drayage services available) to assist you in planning for our convention.

Special note:Exhibitor's fee covers only the space provided and does not include convention registration for individuals working as exhibitors. Pre-registration is recommended either online at or using the 2011 National Convention Pre-registration Form. Be sure to note that you are an exhibitor and the name of your organization on the pre-registration form—this will allow us to have your badges and ribbons in the exhibit hall. DO NOT include payment for registration within the payment made on this form. After the pre-registration period (March 1 through May 31), convention registration opens in OrlandoMonday morning and remains open throughout much of the convention week.

SEND THIS APPLICATION ALONG WITH THE FEE(S) TO:

EXHIBIT COORDINATOR

NATIONAL FEDERATION OF THE BLIND

200 EAST WELLS STREET

BALTIMORE, MARYLAND21230

Enclosed for Exhibitor's Fee(s)………………………….…$______

Enclosed for Electrical Outlet(s)…………………….……..$______

Late Fee for applications received and acceptedafter May 27, 2011

$100 per table ……………………………………$______

Add 3% convenience fee if credit card is used...$______

Total enclosed…………..…………...... ……..….$______

Check number: ______(Made payable to the National Federation of the Blind.)

Credit Card Information

Charge to Credit Card #:______Circle: MC / Visa

Name on Card:______

Billing Address: ______

City______State______Zip Code______

Expiration Date:______Security Code______