US Nuclear Corp.

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US Nuclear Corp.

Exhibitor Contract & Registration

First Responders Congress
March 16-19, 2008
Hyatt Regency Hotel
Albuquerque, New Mexico USA

Please complete the following form to register to attend or exhibit during the premier First Responders Congress.

Click here for Exhibitor Terms & Conditions before filling out this form.

CONTACT AND EXHIBITOR INFORMATION

Company / Organization (Exhibitor Name)

Street Address

Suite / Apt.

City

State

Zip / Postal Code

Country

Telephone

Fax

Company / Organization Website Address

SPONSORS / EXHIBITORS (see details)

	Gold Sponsorship (see details)	$3,000
	Silver Sponsorship (see details)	$2,500
	10 ft. x 10 ft. Exhibit Booth (see details)	$750
	10 ft. x 20 ft. Exhibit Booth (see details)	$1,500

BOOTH SPACE SELECTION (please select four choices from the FRC Exhibit Floorplan. Indicate choices by booth number.)

1st

2nd

3rd

4th

Company / Organization Description

Other Helpful Information

Total Amount Due:

SIGNATURE, PAYMENT, SUBMISSION

1. Due to the competitive FRC sponsor and exhibitor rates, payment is required in full at the time of sponsor or exhibot booth reservation.

2. Cancellations must be made in writing. Please review the Terms and Conditions for the cancellation policy.

SIGNATURE:

By filling in the following fields, the appropriate representative indicates that he or she has read, understands, and agrees to the Terms & Conditions for sponsoring / exhibiting at the premiere First Responders Congress. Submission of this online contract constitutes a legal and binding agreement.

Your Full Name

Title

Date

PAYMENT METHOD

Credit Card	Visa MasterCard American Express (AMEX)
Card Number:
Expiration Date (mm/yy):
Name on Card:

Government Purchase Order
PO Number #
An invoice will be faxed to you.

Checks

Check #

Please make checks payable to "US Nuclear Corp."
Checks must be overnighted and received by March 14, 2008. Mail all check payments to:

US Nuclear Corp.
7051 Eton Avenue
Canoga Park, CA 91303 USA

Additiona questions?
Contact Tom Voss
tvoss@firstresponders.cc
(505) 920-1470

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