Business Name ____________________________________________________________________

1. Host Hotel Quality Inn 870-741-76761210 US 62/65 Harrison AR 72601 VENDOR REGISTRATION FORMGWRRA ARKANSAS DISTRICT CONVENTION RALLYDurand Center1515 Pioneer DriveHarrison AR 72601May 23rd-25th, 2013 PRODUCT(S) OR SERVICES TO BE SOLD AT THIS RALLY/CONVENTION: _____________________________________________________________________________________________ _____________________________________________________________________________________________ SPACE REQUIRED NUMBER OF SPACES SPACE FEE INSIDE – 10X10 1@ $75.00 2@$125.00 3 @ $175.00 4@$200.00 $ 1ST COME WHILE THEY LAST OUTSIDE- 20X20 1@ $100.00 2 @150.00 3 @$190.00 4 @$225.00 $ Business Name ____________________________________________________________________ Address: __________________________________________________________________________ City: _______________________________________State: _____________Zip:_________________ Contact___________________________________________________________________________ Day Phone _____________________________ Night Phone:________________________________ Email address: ____________________________________________________________________ Cell Phone Number: ________________________FAX Number:______________________________ OUTSIDE VENDORS WITH TRAILERS, please include total length including motor home, trailer, tailgate down. For those vendors who wish to contribute to the Rally events as Sponsors please circle yes and include the appropriate amount below. I want to be a MAJOR SPONSOR YES $500.00 (INCLUDES UP TO 5 SPACES AS NEEDED) I want to be a SPONSOR YES $250.00 (INCLUDES UP TO 2 SPACES AS NEEDED) I want to be a SUPPORTER YES $150.00 (includes 1 space) I would like to donate a product for a door prize. YES NO All sponsors and supporters will be given 1 year advertising on the AR District Website and in the monthly AR District Newsletter with distribution in AR, KA, LA, MO, MS, OK, TN, TX, Total Amount Enclosed: $___________ Please return registration and remittance NO LATER THEN March 15, 2013 To: Connie Brandon 13682 West Highway 72, Hiwasse, AR 72739-5705 Make checks and money orders payable to AR-GWRRA PayPal payments accepted at: paypal@argwrra.org For question contact Keith Sanders, Vendor Coordinator Home phone 870-935-7480 Cell phone 870-219-8488 or Email: asst_director@argwrra.org