WIFLE Annual Leadership Training
Vendor Registration and Payment Form

(Right Click to PRINT this form. Complete
and Mail, Telephone, or Fax to the contact 
below.)

Name: _____________________________

Company: __________________________

Address: ___________________________

Address: ___________________________

City: ___________ State: ____ Zip: _____

Phone: ____________________________

Fax: ______________________________

eMail:______________________________

Choose                                         
Ad Upgrade      $1500 __ (Includes one full 
page advertisement in the Conference brochure)
Non-Profit         $750 __
Gov / Business  $995__

Credit Card:
 ___VISA    ___MasterCard    

3 or 4-Digit Reference Number: ________   

Card Number: _______________________

Expiration Date: ____________ 

___________________________________________
Card Holder’s Name (Please print)

____________________________________________
Signature of Card Holder

Check/Money Order Enclosed in amount of $__________

Telephone, Mail or Fax to:
WIFLE
Exhibitor Registration
PO Box 1480
Edgewater, MD 21037-7480
Toll-Free (866)399-4353
(410) 451-0002 ext. 202
Fax at (410) 451-7373
eMail to cheafner@timeandconvenience.com;
>>Please note: WIFLE Privacy Policy

***********************
List the Two Names for your Exhibitor Badges.

____________________________________________

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