Name:          

Company:

Title: 

Address: 

City:    State:    Zip: 

Telephone:    Fax: 

Email Address: 

Honorarium in the Name of:   (your company)

OFFICIAL PROGRAM INFORMATION:
Describe, in 50 words or less, the company information and products/services to be exhibited exactly as you want the information to appear in the official meeting program book.  The information must be received by the CAC with this application OR before July 30, 2004 to be included in the official program book. If this information is not received in time, your company will be listed in the Program without any description. 
 

By submitting this form, I understand that the Carbohydrate Awareness Council reserves the right to accept or decline this application and that if declined I will receive a refund for any monies paid at the time of reservation.  If application is accepted, I understand this application and payment is non-refundable.