June 16, 2016 Vendor table form

           Long Island Alarm Association
P.O. BOX 660, Deer Park, NY
    516-922-7855 phone        www.lialarm.org

   Annual "Were on Fire" Meeting

Thursday June 16, 2016

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 us 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:                    $225.00 Member price (may be applied to a membership package if paid prior to
                                                       package selection, refer to Associate Membership Application)

                                                       $275.00 non 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_______