2017 Mideast Regional Police Collectors Show
Registration Form
NAME: _______________________________________________________________________________
ADDRESS:_____________________________________________________________________________
CITY:_______________________________________STATE:_____________ZIP:____________________
PHONE:_________________________________EMAIL:________________________________________
# of Tables (x $50.00) __________
Are you Staying at Host Hotel (Circle One) Y N
COMMENTS OR REQUESTS: _____________________________________________________________
______________________________________________________________________________________
By signing this form I acknowledge that I have read the reproduction policies and additional policies for the show and agree to abide by the regulations set forth therein. I understand that if I do not abide by these policies, that I will forfeit all rights to my table(s) and all fees associated with them. I further understand that I may cancel my table reservations with a full refund any time up until May 15, 2017. I understand that if I cancel after JMay 15, 2017, then I will not receive a refund for any table fees, and will forfeit the fees associated with them. If not paying for table(s) at this time, I understand that payment is due by May 15, 2017. If payment is not made on or before May 17, 2017, I understand that my reservation is void and I will have to reserve tables again. I further understand that tables are limited and I am not guaranteed that any special requests will be fulfilled.
__________________________________________________________ Total Enclosed: ____________________
SIGNATURE
PAYMENT MAY BE MADE VIA PERSONAL CHECK OR MONEY ORDER. CREDIT CARD PAYMENTS ACCEPTED ONLINE ONLY AT WWW.LOUISVILLEPOLICESHOW.COM
Make checks out and mail payments to:
Jim Clark
9016 Wanlou Drive
Louisville, KY 40272
