Name:

_______________________________________________________________________

Title: ________________________________________________________________________

Company/Organization:

_________________________________________________________

Address: _____________________________________________________________________

City:_______________________________ State:________ Postal Code:__________________

Phone:__ Fax:_

E-mail Address:________________________________________________________________

Exhibitor registration includes one 10' x 8' exhibit space with one electrical outlet and all the following for one attendee: Wednesday evening reception, Thursday luncheon, Thursday evening banquet and Friday morning breakfast. Exhibitors are welcome to attend all conference sessions and are encouraged to attend the Friday morning breakfast session and roundtable discussion. Please indicate booth location preferences and special requirements on the back.

Quantity	Amount	Description	Total
Current FPA Members
	$275.00	Registration - Member Rate
	$125.00	Registration - Additional representative from member organization
Non-members
	$300.00	Registration - Non-member Rate
	$150.00	Registration - Additional representative from non-member organization
Optional Items
	$ 50.00	2002 Membership Dues – save $10 by paying now
	$ 40.00	Additional Banquet Tickets
Total Amount Enclosed

Conference Location - Reservations must be made by October 1

Hilton Daytona Beach Oceanfront Resort

(904)767-7350

2637 S. Atlantic Avenue, Daytona Beach, Florida 32118

Room rates are $110 and are effective a few days before and after the conference, so take some extra time to enjoy the beautiful Daytona Beach area! Contact the hotel directly for reservations.

Return completed form with your payment in the envelope provided or mail to:

Carol Easterling, FPA Secretary

505 Banyan Blvd.

West Palm Beach, FL 33401

If you need to pay at the conference, please fax this form to Carol Easterling at (561)355-4644.

Please complete back of form also!

Booth Location Preferences (see floor plan below):

1^st_______ 2^nd_______ 3^rd _______

Will you be providing a door prize? Yes No

If yes, please indicate the item or notify us at the registration desk when you register. ________________________________________________________________________

What products and/or services will you be exhibiting? This will help us keep competitors from being next to each other.

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Do you have any special requirements? Please indicate below.

Are there any other exhibitors you would like to be next to? If so, please indicate below.

____________________________________________________________________________________________

###

Contact:
Carol Easterling (e-mail: CEasterl@co.palm-beach.fl.us)
for more information.

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October 24-26, 2001

Exhibitor Registration