APPLICATION FOR EXHIBIT SPACE (Deadline: September 15, 2009)

NAME OF FIRM:

_____________________________________________________________________________

CONTACT PERSON to whom all future correspondence regarding this convention should be sent:

Name________________________________________________________________________

Address __________________

City State Zip ____________

Phone: ____ Fax: E-mail: ______

local representative:

Name________________________________________________________________________

Address __________________

City State Zip ____________

Phone: ____ Fax: E-mail: ______

Please reserve:

____ One table @ $350 ____ Additional tables @ $300 each

Amount enclosed: $________ U.S., drawn on a U.S. bank. (Full amount is due upon receipt of application. Please make checks payable to CoTESOL.) I understand that, while every reasonable effort will be made to prevent theft, neither CoTESOL nor the hotel can accept responsibility for loss or damage. DEADLINE: September 15, 2009

Any special requests?____________________________________________________________

Printed name & title of applicant:

Signature of applicant:

Please send this form along with your check to:

Debra Daise

CoTESOL Publishers' Liaison

63 UCB

Boulder, CO. 80309-0063

Tel: 303-735-2717 Fax: 303-492-5515

E-mail: daise@colorado.edu