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Exhibitor Registration Form

Name of Company*

Business Address*	City*	State*	Zip Code*

Telephone Number*
(i.e. 000-000-0000)
Contact Person*	Email Address*

Product*
Booth Fee Information (Registration fee includes continental breakfast, lunch, and afternoon refreshments)* $375.00 (Includes 2 Expo participants) I am a Speaker at the Expo
$ 60.00 for each additional participant above 2 participants
$ 25.00 For each booth attendant only


Name of Expo Participant*	Email Address*	Lunch Selection*
Name of Expo Participant	Email Address	Lunch Selection
Name of Expo Participant	Email Address	Lunch Selection
Booth Attendant	Lunch Selection
Booth Attendant	Lunch Selection
$ ________ Total Payment Amount Make check or money order payable to: LA DEQ Green Business Expo. Mail payment and acknowledgement form to: Ms. Terry Thomas, Louisiana Department of Environmental Quality, P. O. Box 4303, Baton Rouge, LA 70821-4303
Booth Information The spaces may be reserved on a first-come, first-serve basis. It is the responsibility of the exhibiting company to bring all materials needed for display, including maximum 6’x30” table. Booth Size: 6’ x 5’ , 6’x30” maximum table size Booth Setup: 9am - 4:30 pm, Tuesday, August 23 Booth Dismantle: 4:30 pm, Wednesday, August 24 through 4:30 pm Thursday, August 25 Please contact Ms. Terry Thomas, (225) 219-3840 for complete setup information.
Lunch Information Boxed Lunch Selections c atered by La Madeleine French Bakery & Cafe Roast Beef Poboy, Chicken Salad Croissant or Vegetarian Sandwich
RSVP* YesNo

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* Required

Louisiana Department of Environmental Quality

Exhibitor Registration Form