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GenieSpeak - On-Line Genealogy Vendor Registration Form

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(Print the form to mail or fax.)

New Registration (yes/no):
Revision (yes/no):

Payment Method: $30 One Time Registration /Setup Fee: Check or PayPal (see below):

Company Name:
Company Address:

Contact Person:
Business Hours:	Phone number: Fax number:

Email address: WWW address:

Type of Product or Service:

Short Description of your company or products/services:

Will you send handouts for a freebie table at workshops/meetings? Yes or No

Will you consider donating an item or gift certificate for a doorprize? Yes or No

Would you like to attend workshops? Yes or No

In which states or regions:
With how many people minimum in attendance:
Do you or any of your employees also act as speakers who might be available to speak? Yes or No
Who is the contact about the speakers?

Other Services You Offer:
OPTIONAL: Free Ad Space (please limit to 50 words or less):

How did you hear about us?

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