Instructions: Please fill out this form and hit
'Submit' below. This information will go directly to MDVA.
You will receive an email confirmation and an invoice for your costs
within 7 days. This acknowledgment, invoice and all future
correspondences will be sent to the email address provided below.
Please feel free to call MDVA at 517-372-2323 with any questions.
Company Name
Contact Person
Street Address,
City, State, Zip
Telephone
Fax
Email
Classification
Registration Fee *
MDVA Member
Registration Fee *
MDVA Non-Member
Wholesaler
(W)
$375
$400
Vendor (V)
$375
$400
Associate
(A)
$375
$400
Spouse (S)
$100
$125
Young
Adult Child (AC)
$100
$125
Child
(under 12) (C)
$75
$100
*
Registration fees include meal tickets for: Friday Lunch and Dinner
banquet, Saturday Breakfast, Lunch and Dinner
Registration fees may increase after July 15, 2010
Please include classification code next to name
Last Name:
Dates of Stay
Staying for Saturday Dinner
First:
Last Name:
Dates of Stay
Staying for Saturday Dinner
First:
Last Name:
Dates of Stay
Staying for Saturday Dinner
First:
Last Name:
Dates of Stay
Staying for Saturday Dinner
First:
To register more individuals, please submit
additional registration forms.
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