THE UNION LEAGUE OF PHILADELPHIA

The Union League of Philadelphia

140 South Broad Street ? Philadelphia, Pennsylvania 19102

EXHIBITOR INFORMATION

NAME/DATE OF CONFERENCE: NAME OF EXHIBITOR: BOOTH NUMBER: MAILING ADDRESS: E-MAIL ADDRESS: PHONE & FAX NUMBER: ON-SITE CONTACT:

NEEDS: ______ 20AMP-120 Volt Power Source $50

______ Power Strip

$10

______ Extension Cord

$10

______ Internet Access(Hard Wire) $300

______ 47" LCD Monitors

$375

______ 42" LCD monitors

$300

***An additional 20% Service Charge and 8% Philadelphia Sales Tax will be added to all resources. Prices are listed per room per day. For special requests please contact The Union League AV department at (215)-587-5589.

BILLING INFORMATION: Please return this completed form, along with the credit card authorization form attached to The Union League Private Events Office by fax 215-587-5562 or e-mail, cheilladas@. Forms must be submitted (7) business days prior to the event.

CREDIT CARD PAYMENT AUTHORIZATION

I, (Signature)

, authorize The Union League of

Philadelphia to generate Deposit, Pre-Payment and Balance Due charges against my credit card account

for payment to The Union League of Philadelphia.

Name of Event:

Date:

Event Date:

CARDMEMBER INFORMATION

Credit Card Number:

American Express

Expiration Date:

/

Security Code:

Amount: $

Name: (please print)

Address:

Visa /

______ MasterCard

______

Phone Number: (

)

Email Address:

__________________________

140 South Broad Street Philadelphia, Pennsylvania 19102

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