Vendor Application

Complete the registration form below for each event you wish to attend.

Registration fee (per event) is $200

Please choose an event

Company Name

Company Website

Company Address (Street, City, State, Zip)

Main Company Number

Primary Contact Name

Primary Contact Email

Primary Contact Phone

Please list the names of each representative that will be present for this event

Description of Giveaways/Demonstration

Please provide a description and quantity of all items you plan to give away and/or the topic/demonstration you plan to present:

Attestations

As a vendor, I am responsible for providing my own equipment, ie: table cloths, decorations, giveaways. (One 6 foot table and two chairs will be supplied for each company.)(required)

I understand and agree

As a Vendor, I understand that all fees are non-refundable as they are used to support Caregiver's Respite.(required)

I understand and agree

As a Vendor, I am responsible for ensuring that at least one representative will remain on-site throughout the duration of the event.(required)

I understand and agree

As a Vendor, I am responsible for leaving the area designated for my organization, in the same condition as it was presented.(required)

I understand and agree

Completion of this application, is not a guarantee of acceptance as a vendor. Your submission will be reviewed within 10 days. (required)

I understand and agree

Electronic Signature

By typing your name below and attesting to the statements above, you, as a representative of your company, verify that the information contained in this Vendor Registration form is true to the best of your belief. Caregiver's Respite or their affiliates will not be held liable for lost, stolen or damaged goods, or any injury incurred during the above selected event.

Date (YYYY-MM-DD)

Thank you for applying to be a vendor!

You will receive email confirmation of the status of your application within 10 days of form submission.

Should your organization be chosen as a vendor, you will receive instructions on how to pay your Registration Fee.