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Step 1: Company and Contact Information
Required Fields*
Company Name*
Specialty*  
Address*
Address Line 2
City*
State*
Zip*
Phone*
Ext.

Fax

Company Contact Name:*

FirstLast

Contact Email*

Exhibitor Package* Purchasing Exhibitor & 2 Attendants - $700 - Exhibit Table & Two(2) Attendants

Purchasing Exhibitor & 3 Attendants - $1000 - Exhibit Table & Three(3) Attendants

Purchasing Exhibitor & 4 Attendants - $1300 - Exhibit Table & Four(4) Attendants

Fill out only the number of attendees that match your purchase.
Default Attendee(1) Name

FirstLast

Attendee 1 Title
Attendee 1 Contact Email
Default Attendee(2) Name

FirstLast

Attendee 2 Title
Attendee 2 Contact Email
Additional Attendee(3) Name

FirstLast

Attendee 3 Title
Attendee 3 Contact Email
Additional Attendee(4) Name

FirstLast

Attendee Title
Attendee Contact Email




Merchant Services
February 1-2, 2018 Online Conference Registration
The Eighth Annual Louisiana Workers’ Compensation Educational Conference