June 11, 2015 Vendor Table Form

                                                                                       P.O. BOX 660, Deer Park, NY 11729

                                                                                        631 424-0119 phone
                                                                                            www.lialarm.org
 
                                           General Meeting – Annual Round Table
                                                Thursday, June 11th, 2015
                                                                      Vendor Exhibits/Dinner 6:30-10:00 pm
                                                                                Set up 5:30pm

                                                   UPSKY Long Island Hotel 

                                                                   Formerly Sheraton LI

                                                                110 Motor Parkway Hauppauge, NY 11788

Please let me know if you can donate any item(s) to be raffled off.  They can be mailed to the above address or call the above # for arrangements to be picked up.

Cost:  $250.00   Non-member price

                   $200.00   Member price

Vendor/Manufacturer Name:_______________________________

 ATTENDEE Name:              _______________________________

 Contact telephone #:            _______________________________

 Payment Type:   ____check                       ____Credit card  (Please check one)

____ Mastercard                  ____Visa          ____American Express

Card #:  __________________________  Zip code____________  (affiliated with card)

 Exp ___ ___ / ___ ___                            Code: ___ ___ ___ ___ 

 Do you require Electric at your table?

 YES______                NO_______