Eastern Exposition for Cleaning Professionals

Registration Form
On-site Registration Sponsored by
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(Complete ONE form per company and submit a business card for each company
attendee. Deadline for pre-registration is April 30, 2010.)
PRIMARY CONTACT NAME
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COMPANY
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ADDRESS
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CITY
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PHONE
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FAX
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STATE
Registration Fees — NJSSA & NESSA Member Registration
NJSSA & NESSA Members receive 6 free registrations with their paid membership dues and
may attend Supply Line 2010 at no charge. Membership dues for 2010–2011 must be paid to
pre-register before April 30, 2010. This offer is not available at on-site registration.
2010–2011 NJSSA Membership Dues (6 attendees included with membership) $275 $__________
2010 NESSA Corporate Member Dues $125 $__________
Additional Paid Member Registrants
_____ @$ 25 per person $__________
Non-Member Registration
Cleaning Professional
_____ @$ 25 per person $__________
Distributor
_____ @$ 25 per person $__________
Manufacturer Representative
_____ @$ 25 per person $__________
Non-exhibiting Manufacturer
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EMAIL
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ZIP
_____ @$960 per person $__________
Seminar/Event Fees (With paid admission, fees are per person) MEMBER NON-MEMBER TOTAL
How To Reduce Cleaning Costs _____ @$ 25 _____@$ 50 $__________
(For distributors and cleaning professionals)
ISSA CIMS I.C.E. Workshop:
Register at www.issa.com/standard/ice Before April 23, 2010 (For distributors,and cleaning professionals)
(For distributors and cleaning professionals)
Golf Outing _____@$105 _____@$105 $__________
Awards Luncheon Only _____@$ 25 _____@$ 25 $__________
_________________________________________ ________________________________________
_________________________________________ ________________________________________
TOTAL DUE: Make Checks Payable to NJSSA
$__________
Or pay by Credit Card ( ___Amex ___ MC ___ Visa ___ Discover)
Card Number: ___________________________________ Exp. Date: _____________ CVV:_______
Name on Card: _______________________________ Signature: _____________________________
Billing Address: _____________________________________________________________________
City: ________________________________________ State: ____________________ Zip: ________
Supply Line 2010, NJSSA and NESSA are managed by Peak Management Solutions.
All credit card charges will appear on your statement as Peak Management Solutions.
Company Registrants: (Make additional copies of the registration form if needed.)
_________________________________________ ________________________________________
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_________________________________________ ________________________________________
_________________________________________ ________________________________________
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_________________________________________ ________________________________________
_________________________________________ ________________________________________
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Company business:
Distributor Buildings & Grounds Industrial Maintenance, State, or Federal Facilities
Manufacturer Rep Cleaning Professional Other______________________
Non-exhibiting Manufacturer Executive Housekeeping
RETURN REGISTRATION FORM TO:
New Jersey Sanitary Supply Association
P.O. Box 435, Butler, NJ 07405-0435
Or register online at: www.njssa.net
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