2019 NJ/PA PHCC Trade Show: Exhibitor Registration

Personal Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:

Business Information

• * Company:
• * Address 1:
• Address 2:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Phone:
• * Name for Booth Sign
• * Type of Product being displayed?

Custom Information 1

• *

  How Many Booths?

  • 1 = $995
  • 2 = $1600
  • 3 = $2000
  • or Vehicle 1 = $1600
• *

  Will you require Electric in your booth?

  • Yes :Electric (1) 120v amp outlet = $86 (onsite fee will be $130)
  • No: I do not need electric in my booth
• *

  Payment Options

  • Send check payable to NJPHCC 189 E. Bergen Pl. Red Bank, NJ 07701
  • Request online invoice to pay with CC

Exhibitor Badge Information

You may add a maximum of 10