DA Vendor - Exhibitor

DA Vendor - Exhibitor

First Name

Last Name

Address

City

State

Zipcode

Home Phone

Cell Phone

Email

Congregation

Congregation City

Organization or Company

Organization Website
if applicable

Products
items you will be selling, if any

Electricity
I would like to be near an electrical outlet if possible.

Click for YESClick For No

Payment
I will pay my table fee by:

checkcredit card

Instructions

After you click SUBMIT FORM, you will be directed to a payment page where you can pay the $35 table fee and purchase lunch. If you do not wish to pay by credit card (via PayPal), please mail your check to:
Central Midwest District UUA
1555 Sherman Avenue Suite 345
Evanston, IL 60201
Call the District Office if you have questions, 312-636-9724.

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