Registration Propane Summit Registration Step 1 of 5 20% Registration ContactCompany Name First Last Email* PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Are you filling out this form prior to March 15, 2020?Please note that registrations that are completed prior to March 15, 2020 qualify as an Early Bird registration and will come with additional savings. Yes No SponsorshipsAre you interested in becoming a sponsor? Yes No Propane Summit Sponsorship Opportunities (select one)Call me with more informationPresenting Sponsor- $1,500 (includes vendor table & 4 attendees)Event Sponsor-$750.00 (includes vendor table and 2 attendees)NameOrganizationEmail Address NameOrganizationEmail Address NameOrganizationEmail Address NameOrganizationEmail Address Do you want a vendor table? Yes No What kind of Exhibit Do You Have? Inside Outside Do you want to register more attendees than your sponsorship allots? Yes No Total $0.00 Vendor RegistrationPlease note, you do not need to fill this out if you are participating in a sponsorship.Do you want to exhibit at the Propane Summit? Yes No How Will You Be Exhibiting? (select one)Exhibitor registration comes with one attendee registration. Inside Exhibitor - $350Outside Exhibitor -$350(Non-Member) Inside Exhibitor - $450(Non-Member) Outside Exhibitor -$450How Will You Be Exhibiting? (select one)Exhibitor registration comes with one attendee registration. (Member) Inside Exhibitor - $300 EARLY BIRD RATE(Member) Outside Exhibitor -$300 EARLY BIRD RATE(Non-member) Inside Exhibitor - $400 EARLY BIRD RATE(Non-member) Outside Exhibitor -$400 EARLY BIRD RATEWho will be attending?NameOrganizationEmail Address Do you want to register more attendees than your vendor registration allots? Yes No Total $0.00 RegistrationOnly fill this out if you want to add additional registration separate from your sponsorship or exhibitor registration.Select a registration type (at a discounted early bird rate)Early Bird Member Registration - $69Early Bird Non-Member Registration - $99Quantity of AttendeesSelect a registration typeRegular Member Registration - $99Regular Non-Member Registration - $129Quantity of RegistrationsNameOrganizationEmail Address NameOrganizationEmail Address NameOrganizationEmail Address NameOrganizationEmail Address NameOrganizationEmail Address NameOrganizationEmail Address NameOrganizationEmail Address NameOrganizationEmail Address NameOrganizationEmail Address NameOrganizationEmail Address Total $0.00 How would you like pay?*If you would like to pay now by credit or debit, click where it says "Pay with Debit or Credit Card" on the grey box on the PayPal login screen. Contact Jen Grace 207-729-5298 with any questions! Credit Card Bill Me ~ Pay Later Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Total $0.00 HiddenPaid Field Paid PhoneThis field is for validation purposes and should be left unchanged. Δ
