Clinic Vendor Registration

• Clinic Information

  Enclosed you will find information about reserving a table or tables to display your products at our annual clinic on April 26-27. Once again the clinic will be held at Lawrence North High School on the Northeast side of Indianapolis.
  
  If you would like to reserve a table, please complete the information below and return ASAP.
  
  Also enclosed is information regarding various levels of corporate sponsorship related to advertising on the IBCA website http://www.ibcacoaches.com. We would be happy to discuss with you our corporate sponsorship options.
  
  

  Clinic Dates	April 26-27, 2019	Set-up 4:00pm Friday, April 26 Tear-down Noon Saturday, April 27
  Clinic Site	Lawrence North High School, 7802 Hague Rd., Indianapolis, IN 46256
  Hotel	Hilton Garden Inn-Indianapolis Northeast/Fishers 9785 NOrth By Northeast Blvd. Fishers, IN 46037 Room rate is $159.00 Reservations: 317-577-5900

  Group code is "IBCA/smerf" and cut off to register at that rate is 4/4/2019 a second hotel option is *Hampton Inn-Indianapolis NE 6817 E 82nd St, Indianapolis, IN 46250 Room rate: $139 Reservations: 317-576-0220 cut-off date is 3/25/19 Link: Indiana Basketball Coaches Assoc.
• Name of Business*
• Person in charge
  First Last
• Email*
• Address*
  Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
• Phone*
• Fax
• Description of product*

• Booth Information

• Booth*

  Fee is $200 for each 5-foot table. Enter how many tables you would like in the field below.

  Price: $200.00 Quantity:
• Total
  $0.00
• How would you like to pay?*
  Select OneOnlineBy Mail

• Mailing Instructions

  Make check payable to "IBCA." Please print and return completed form (you will receive form after submission) with fee to Pat McKee.
  
  The IBCA would appreciate each vendor donating a product for various door prizes and drawings at the clinic. Pat or Lori will be glad to puck up donations when you arrive. Thank you in advance.
  
  If you have questions regarding the clinic, please contact Steve Witty, IBCA Executive Director, at 317-837-1606 or 317-698-2617. Check out the IBCA website at http://www.ibcacoaches.com.

• Credit Card

• Credit Card*
  Discover

  MasterCard

  Visa

  Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date   Security Code Cardholder Name