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Major Initiatives:

2009 Indiana Lead-Safe and Healthy Homes Conference

November 4 & 5, 2009

Registration Form for Exhibitors/Vendors

Marten House

1801 W. 86th St.

Indianapolis, IN 46260

The Task Force really appreciates your participation in and support of the Indiana Lead Safe and Healthy Homes Conference.  We welcome your feedback on how to make the conference as useful as possible for your company and our attendees.  This year, we are providing the option of a one or two day registration, as well as opportunities for vendors to sponsor the Conference breaks.  Click here for more information about sponsorships.

Please register as an exhibitor by sending an email to Lauren Stanisic at stanisic@ikecoalition.org with the following information:

• Organization/Company Name

• Address

• Phone

• Fax

• Email

• Which day or days you plan to attend

• Name(s) and contact information for those who will be attending

• Amount Due

• Payment Method (check or credit card--include expiration date, mailing address of cardholder and security code please!)

• Any Special Arrangements or Needs

You can also use print this page or download registration form in Word and:

• Email completed form to Lauren Stanisic at stanisic@ikecoalition.org; 

• Fax it to IKE at 866-234-8505; or

• Mail it to IKE at: 

                3951 N. Meridian St., Suite 160

                Indianapolis, IN  46208

We accept checks or credit cards.  It is best if payment is received before October 12.  If we have to submit invoices after the conference, there is an additional $15 billing fee for each invoice sent. 

If you are paying by check, please make check payable to "Lead-Safe Indiana Task Force" and mail it to 3951 N. Meridian St., Suite 160, Indianapolis, IN  46208. 

If you are paying by credit card, Visa, American Express and Mastercard are accepted.  Please provide credit card number, expiration date, mailing address of cardholder and security code.  Improving Kids' Environment, Inc. will process the payment on behalf of the Task Force.

IKE will confirm registrations by email within four business days of receipt.  Please contact Lauren Stanisic at stanisic@ikecoalition.org or Janet McCabe at 317-902-3610 or mccabe@ikecoalition.org with any questions or concerns. 

ORGANIZATION ____________________________________________

ADDRESS __________________________________________________

CITY_______________________________________________________

STATE, ZIP _________________________________________________

PHONE _____________________  FAX __________________________

E-MAIL ____________________________________________________

ATTENDING  ON:  _______ Nov. 4    ______ Nov. 5   ________ Both

NAME /EMAIL OF ATTENDEES _________________________________

__________________________________________________________ 

__________________________________________________________

Registration Fee $______ 

I will pay by   __ check   __ Visa  __ Mastercard  ___Amex

If paying by credit card, my card # is ______________________________

and my card expiration date is __________________

and my security code is _________

and the mailing address of the cardholder is ____________________________

_____________________________________________________________

If you need special arrangements to attend the conference, please contact Lauren Stanisic at stanisic@ikecoaltion.org or Janet McCabe at 317-902-3610 or mccabe@ikecoalition.org by October 12 so arrangements can be made.

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