Questions? Please contact NANCY SCHILLING...
nancejay@hotmail.com
618.853.2656
IESMA Secure Order Form
Illinois Emergency Services Management Association

Vendor Order Form


IESMA

Select the item(s) below that you would like to order. Your transaction will be confirmed by email.

Tuesday, 9/6 Hospitality Host ($ 1000 each) Quantity:
Wednesday, 9/7 Hospitality Host ($ 1000 each) Quantity:
8' Table ($ 350 each)
1st Add'l Table ($ 200 each)
2nd Add'l Table ($ 200 each)
3rd Add'l Table ($ 200 each)
T-1 Internet Connection ($ 150 each)
Electricity ($ 0 each)
1st Add'l Lunch ($ 20 each)
2nd Add'l Lunch ($ 20 each)
3rd Add'l Lunch ($ 20 each)
4th Add'l Lunch ($ 20 each)

GENERAL INFORMATION
First Name: Last Name:
Address:
City: State: Zip:
Country:
Phone Number:
E-Mail Address:
Company: Position:
Attendee Name: Attendee Phone:
Attendee Name: Attendee Phone:
Attendee Name: Attendee Phone:
Attendee Name: Attendee Phone:
Please include a short list of the products or services your company provides:


Conference room registrations must be done directly with IEMA Conference Hotels

The Illinois Emergency Services Management Association

2011 IEMA CONFERENCE
Vendor Conference Registration Form
September 6th - 8th, 2011

Pay by credit card below!
Checks must be mailed to:

IESMA
Nancy J. Schilling, Treasurer
P.O. Box 99
Evansville, IL 62242-0099
Make Checks payable to IESMA


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Hotel Reservations must be made separately by referring to the IEMA Website: