Onsite Name Badge Request Form Conference Contact InformationCompany Name* Booth or Table Number*This number can be found on the label of your vendor packet or on your ID sign (for pipe & draped booths).Your Name (NOT the name for the badges)* First Last Phone*Email* Conference SelectionPlease make your selections carefully. In order to receive a complimentary name badge swap, the badge being replaced must be returned back to exhibitor registration prior to the new badge being printed. For new badge orders there is a $100 fee per badge. You may pay for the badges at the end of the form using a credit card.Which Conference are you Attending?* Judges & Commissioners in Abilene V.G. Young Institute's School for County Tax Assessor-Collectors Number of Replacement Badges Needed Quantity* Price: $0.00 Quantity PLEASE NOTE: to qualify as a replacement badge, exhibitor registration must receive the badge being replaced prior to printing a new badge. Without the incorrect badge being turned in a $100 charge will be applied.Number of Additional Badges Needed Quantity* Price: $100.00 Quantity Total for Additional Badges $0.00 Booth Personnel*NameTitle Payment InformationPayment Method* Replacement Badges Only - Zero Balance Credit Card Card Billing Address Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name CAPTCHAEmailThis field is for validation purposes and should be left unchanged. Δ
