Be A Vendor! -

Vendor Name *

First

Last

Vendor Email *

Vendor Phone

Company Name

Company Website

Main Company Number

Company Address (Street, City, State, Zip)

Please Choose an Event

WOMEN WHO CARE BOOTCAMP – $50
Annual Day of Respite (Sept 2024) – $100
Book Review Talk – $100
Starting Hard Conversations Workshop – $50
Caregiving Resources 101 Workshop – $50

Please list the names of each representative that will be present for this event

Please provide a description and quantity of all items you plan to give away and/or the topic/demonstration you plan to present:

Attestations

As a Vendor, I understand that all fees are non-refundable as they are used to support the programs provided by Janice Williams, RN. *

I understand and agree

As a Vendor, I understand that I am responsible for providing my own equipment – ie: table cloths, decorations, giveaways (One 6 foot table and two chairs will be supplied for each company). *

I understand and agree

As a Vendor, I understand that I am responsible for ensuring that at least one representative will remain on-site throughout the duration of the event. *

I understand and agree

As a Vendor, I understand that I am responsible for leaving the area designated for my organization, in the same condition as it was presented. *

I understand and agree

Completion of this application, is not a guarantee of acceptance as a sponsor or event vendor. Your submission will be reviewed within 10 days. *

I understand and agree

Electronic Signature *

By typing your name above and attesting to the statements above, you, as a representative of your company, verify that the information contained in this Vendor Registration form is true to the best of your belief. Janice Williams, RN or their affiliates will not be held liable for lost, stolen or damaged goods, or any injury incurred during the above selected event.

Date *