Company _____________________________________________________________________________

1. 2013 Time Warner Cable Business Class CenterState Business ShowcaseOctober 17th, 2013 – Oncenter Exhibit Registration Company Name ______________________________________________________ (as it should appear on your booth sign) Sign up by 3/1/13 and save $50! Please make checks payable to: Galaxy Events, LLC Please mail this registration form and payment to: Galaxy Events, LLC 235 Walton Street, Suite 100 Syracuse, NY 13202 Attn: Carrie Wojtaszek Phone: 315-471-9597 Fax: 315-472-1888 carrie@galaxyeventscompany.com ** Business Referral Suggestions ** Please list any company(s) that you think might be interested in the 2013 CenterState Business Showcase. ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ Description of Business ______________________________________________________ (10 words or less) Company _____________________________________________________________________________ Contact ______________________________________________________________________________ Address _______________________________________________________________________________ City ____________________________________ State __________ Zip ___________________________ Phone _____________________________________ Fax _______________________________________ E-mail _________________________________________________________________________________ Website ______________________________________________________________________________ Booth Fees (based on a 10’x10’ booth) Company Size CenterState Chamber Non-Member # of Booths #of employees Member Fee Rate 1 - 5 $575 $725 _______ 6 - 50 $625 $775 _______ 51+ $725 $875 _______ Yes, I am interested in sponsorship. Please contact me. Payment Information Check Visa MC Discover Amex Cardholder Name ____________________________________ Card Number ________________________________________ Exp. Date ____________________________________________ Address Associated w/ CC: Street _____________________ City _______________________ State ________ Zip _________ 3 Digit (Amex is 4) Security Code ______________________ Authorized Signature__________________________________