From: Title:

Email Address:

Company:

My Fax Number: Voice Phone#:

Street Address:

City: State: Zip Code:

My Business Specialty:

(Business Specialty information will be used to Avoid placing direct competitors at adjacent tables.  Broad Categories include:

Unless you are in an entirely different line of business, please pick one of these.

My Special needs are (Please check all that apply)

need to be next to a wall please,

exhibit will not fit in a 6 foot space, need more

thank you, but I will not need a table

Yes, (Please check box) I want to exhibit at the Annual Seminar on August 7, 2008 at the Ritz Charles, Carmel, IN.

I understand that upon receipt of the Acknowledgement Email (by June 30, 2008, 5:00pm) that I am on the reservation list AND that the Exhibition Fee of $180.00 payable to IWCI must be received PRIOR to July 7, 2008, 5:00pm; mailed to:

Milestone Contractors, LP

c/o Kathy Chaney, IWCI Vendor Liaison

PO Box 421459

Indianapolis, Indiana 46242

An acknowledge email of payment receipt will be made by July 9, 2008, 5:00pm.  If the $180.00 fee is not received by the above deadline, I understand my reservation is forfeited and can be replace from the waiting list.

I understand the above statement and agree. (Please note - your form will not be submitted unless you enter the word "agree" in the box provided)