2007 Larry E. Blackburn Memorial Show Registration Form

NAME:  _______________________________________________________________________________

ADDRESS:_____________________________________________________________________________

CITY:_______________________________________STATE:_____________ZIP:____________________

PHONE:_________________________________EMAIL:________________________________________

# of Tables __________   Display Space Needed _______________  # of Chairs _______________

Are you Staying at Host Hotel (Circle One)   Y    N

COMMENTS OR REQUESTS: _____________________________________________________________

______________________________________________________________________________________

By signing this form I acknowledge that I have read the badge and reproduction policies for the show and agree to abide by the regulations set forth therein.  I understand that if I do not abide by these policies, that I will forfeit all rights to my table(s) and/or display space and all fees assocated with them.  I further understand that I may cancel my table reservations with a full refund any time up until July 25, 2006.  I understand that if I cancel after July 25,2006, then I will not receive a refund for any table or display fees, and will forfeit the fees associated with them.  If not paying for table(s)  at this time, I understand that payment is due within 14 days of the registration date.  If payment is not made during that time frame, I understand that I may not receive table and/or display space at the show.

__________________________________________________________    Total Enclosed:  ____________________

SIGNATURE

PAYMENT MAY BE MADE VIA PERSONAL CHECK OR MONEY ORDER

Mail Payments to:

Jim Clark

9016 Wanlou Drive

Louisville, KY  40272