Booth Registration Form

Please note: Although it is most unlikely that you will experience any problems responding to this form, certain non-standard browsers will not respond properly. If you experience any difficulties, (or if you are not using a forms-capable browser) you may email your response to this form to: .

Booth Name:

Contact Person:

Address:

City:

State:

Zip Code:

Phone:

Fax:

E-mail:

One booth is considered one table with two to four chairs.  Additional tables and chairs will
be considered more than one booth, and you will be charged accordingly.

Number of people in your group:          
Number of tables you will need:          
Number of chairs you will need:

Will you need electricity for your booth? Yes No   (If yes, add $25.00 to booth fee.)

Is there anything else that we may accomodate you with?

We are offering t-shirts to help you commemorate this event.  T-shirts are $18.00 each.
                         Number of LG:          
                         Number of XL:

Would you like to make a donation to help defer other costs?:

              Total (booth fee plus t-shirts plus donation):

You may pay online by using a credit card, or mail us payment. 
Please enter credit card information, or mail payment to:

YOUTHpride
Registration Dept.
P.O. Box 20716
Indianapolis, IN 46220

Visa/Mastercard Discover American Express 
Card Number:     
Expiration Date:

Please give us any comments or questions you may have:

Thank you for registering your booth with us!
If you paid with a credit card, we will send you a confirmation e-mail soon. If you are paying by cash, please mail payment promptly. We will notify you when your booth has been processed by either e-mail or postal mail. Remember to report to the Registration booth upon arrival at the event. Thank you for supporting us!

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