The Municipal Clerks’ Association of New Jersey

http://www.njclerks.org/cn/webforms/form.cfm?FormID=184&tpid=18590

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*Fields in Red are required.

MCANJ Conference Exhibitor Application

* Fields in red are required

Exhibitor Information

Company/Organization Name:

Contact Person:

Phone:

Email:

Website:

Address:

City:

State:

Zip:

Type of Business:

List two individuals who will be at the exhibitor’s booth and require Exhibitor IDs and Meal Tickets:

1) First Name:

Last Name:

Title:

2) First Name:

Last Name:

Title:

Will you provide a door prize?:

Yes No

Indicate companies that may be your competitor to make sure your spaces are placed apart:

Before submitting this form please email your advertisement to the MCANJ Website Administrator at websitemanager@MCANJ.us. The ad needs to be submitted in JPG, TIFF, or BMP format. Include your Business Name, Logo, Address, Phone Number and Website or any combination thereof. If you do not provide an advertisement, we will format an ad utilizing your Business Name and website address as provided in your registration form.

No ads will be placed until payment is received.

Registration Deadline is March 1, 2024

Payer Information

Billing Name:

Address:

Address 2:

City:

State:

ZIP Code:

Daytime Phone:

Payer E-mail Address:

Payment Information

Payment Amount:

$775 - Standard Reg. (w/ up to 2 Reps)

$950 - Standard Reg. with 1 additional Reps (3 total)

$1125 - Standard Reg. with 2 additional Reps (4 total)

Payment Method:

Credit Card:

Convenience Fee:

Credit Card Number:

Sec. Code:

What is the Security Code?.

What is this and why do I have to do it?
Due to the amount of credit card fraud over the internet, banks will soon REQUIRE this information to process credit card orders online - you can expect to see it used everywhere in the very near future. Your benefit is that it prevents any fraudulent charges using your credit card, i.e. no one can pick up an old receipt of yours and use that info to fraudulently use your credit card. Thanks for your cooperation.

American Express
4 digits on front of card

Visa and Mastercard
last 3 digits on back of card

Note: The digits are printed on your card, rather then stamped in the plastic like the digits in your credit card number.

Exp. (Month/Year):

(2 digits, Range: 24-34)

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