Vendor Table Sponsorship Application
Vendor:_________________________________________________
Address: _______________________________________________
________________________________________________________
Telephone:______________________________________________
Contact: ________________________________________________
E-mail: _________________________________________________
Optional Support: All donated monies support Education and Training of the Biomeds, Guest Speakers and Future Meetings.
Price QTY Total
Vendor Fair Fee: $________ X _____ = _______
Additional Dinner(s): $40.00 X _____ = _______
(Optional Support) $______________ = _______
Grand Total: $_______________
Please fax your application to (209) 942-2572
(attn: Cindy Schaffner) and mail your check
(made out to "CMIA Inland Empire") to:
Conquest Imaging
Attn: Cindy Schaffner
3728 Imperial Way #B
Stockton, CA 95215
Please state the purpose of your payment on your check.
For additional information, please contact Cindy Schaffner at
cschaffner@conquestimaging.com or by phone at (209) 942-2654.
This event is a CMIA Chapter Event.
All monies generated will go to the CMIA Inland Empire Chapter!
