Vendor Registration

40th Annual NWCUCA Conference – June 4th, 5th & 6th, 2015

To register online, fill out the form below and your registration will be sent in. You may also pay for additional advertising in our directory $50-$250 per ad based on size and graphics, please contact me for pricing

The cost of the conference ranges from $400 to $600 per vendor, depending on membership, booth and size. Additional materials are $25 per person.

After completing the form below, registration funds must be made payable to NWCUCA and mailed to: NWCUCA c/o Jennifer Haines PO Box 784 DuPont, WA 98327

Vendor Registration Form

First & Last Name (required)

Attendee First & Last Names (if filling out on behalf of a group)


Mail Address, City, State, Zip

Phone Number (required)

Email Address (required)

Company Website

Sponsorship Level (required)
Sponsored funds are applied to Speakers, Entertainment, Meals, Breaks, and Golf. Additionally, you may choose to sponsor a specific function entirely by indicating it in the "Additional Comments" field below, or by contacting Jennifer Haines at (866) 968-7128 ext. 3216.
 Platinum ($750) Gold ($400) Associate ($200)

Booth Size (required)
Booth sizes vary based on table length (6' and 8') and location. Please indicate your preference.
Only 6-foot booths are available at this time.
 6-Foot Booth ($500)

We accept separate donations for the Conference Scholarship Fund. We will provide recognition for all donations in our Conference Notebooks, Directories and on a Posted Event board at the conference. If providing a donation, please enter the value in the field below. Please indicate whether this donation should be applied to the scholarship fund, the general fund or another activity in the "Additional Comments" field at the end of this form.

Extra Meals
All below meals are included in your registration. Please only select additional meals if you will have a non-registered guest joining you. To select multiple meals, hold the Control key during clicks.

Payment Preference
 I will pay by mailing a check after I submit this form Please email me a Paypal invoice, and I will pay online

Additional Comments


Your request will be processed as soon as possible. For more registration information, contact Jennifer Haines.

Please include payment for membership, donations, and extra meals with your registration fee. If you have any special dietary needs, please let us know as soon as possible. Every effort will be made to accommodate your request.