19th Annual Women's Business Conference - Exhibitor Application

Personal Information

• * Company Name
• * Prefix: --Choose-- Mr Mrs Miss Ms Dr Prof Rev Fr Sr Rabbi
• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Website or social media page (if available):
• * Address 1:
• * 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:
• * Cell Phone:
• *

  PAYMENT METHOD: How would you like to pay for your exhibitor table?

  • I will send a check: Western Dairyland EOC, PO Box 125, Independence, WI 54747 (memo: WBC)
  • I would like to pay via digital invoice (our staff will send you a PayPal invoice via email)

• Promo Code

  Enter Code: Apply

• Fee

  Type	Fee
  Exhibitor Fee ($159 until Aug. 1st) $199.00 after Tuesday, August 2, 2022	$159.00
  Free Exhibitor Table --> Carried over from 2021	No Charge

Demographics

• *

  Gender

  • Female
  • Male
  • No Response
• *

  Race

  • American Indian or Alaska Native
  • Asian
  • African American
  • Native Hawaiian / Pacific Islander
  • White
  • No Response
• *

  Ethnicity

  • Hispanic
  • Non Hispanic
  • No Reponse
• *

  Do you consider yourself to have a disability?

  • Yes
  • No
  • No Response
• *

  Do you require special assistance, equipment, or considerations in accordance with ADA requirements?

  • Yes
  • No
• *

  Do you have an ADA permit and/or license?

  • Yes
  • No
• *

  Military Status

  • Spouse of Military Member
  • Service Disabled Veteran
  • Veteran
  • Member of the Reserve
  • Member of the National Guard
  • Active Duty
  • No Military, Reserve, or National Guard Service

EXHIBITOR STAFF Information

You may add a maximum of 1

Additional information

• * Please list any special requests you may have:
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• * All exhibitors are required to provide a RAFFLE PRIZE (min. value of $25) or donate $25 in cash --> see end of form. Please let us know what item(s) you'd like to donate. This prize doesn't have to be dropped off before the event. Just bring it with you and place it on your exhibitor table at the Women's Business Conference. Each exhibitor will get a bucket for raffle tickets.
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• *

  I hereby acknowledge the raffle prize requirement: Each exhibitor must donate a raffle prize (min. $25 value or more) or $25 in cash.

  • Yes
  • No
• *

  I hereby acknowledge that I've read the exhibitor parking policy: Exhibitors can unload at the event venue (day before or morning of event), but will have to move their vehicles to another parking lot for the remainder of the day. The parking spots that are available to us are for (un)loading only. Unfortunately, we've had some exhibitors who disregarded this guidance and ended up with a fine from UW Eau Claire. We'd like to avoid this and make it a fun day for all!

  • Yes
  • No
• *

  I hereby acknowledge the set-up and clean-up times for my table: Tuesday, October 11th from 3 - 7 pm and Wednesday, October 12th from 6 - 7 am. We ask our exhibitors not to clean up before 3 pm on October 12th due to the announcement of the raffle prizes. Clean-up can start at the same time as the last presentations of the day, but you're also welcome to attend the last session yourself if you'd like, and start cleaning up afterward.

  • Yes
  • No
• *

  I am planning on setting up my table on:

  • Tuesday, October 11th from 3 - 7 pm
  • Wednesday, October 12th from 6 - 7 am
  • Not sure yet
• Wisconsin Seller's Permit # (learn more here: https://www.revenue.wi.gov/Pages/faqs/pcs-seller.aspx)