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GenieSpeak - Genealogy Vendor Registration Form

Print form (set printer to portrait). Type or print plainly and send to:
GenieSpeak , %Helen Staiger, 240 Duffy Rd., Slippery Rock, PA. 16057
Fax (724) 794-4627

Company Name:


Address:
Payment Method: $30 One-Time Registration /SetUp Fee: Check (payable to Helen Staiger) or PayPal ____________
PHONE: Business#:___________________________Business Hours:____________________
E-mail address:_____________________________________Fax#:______________________
WWW address:
Contact Person:
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 . . . . . no
  • Will you consider donating an item or gift certificate for a doorprize? . . . . . yes . . . . . no
  • Would you like to attend workshop? . . . . . yes . . . . . 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 . . . no
  • Who is the contact about the speakers?

    Other Services You Offer:




    OPTIONAL: Free Ad Space (please limit to 50 words or less) Use additional sheet of paper as necessary.
    HMS mail@Geniespeak.com