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2019 RECOVERY SUMMIT

Date: Friday & Saturday August 2-3, 2019

Location: Arkansas State University, Student Union 102 N Caraway Rd, Jonesboro AR 72401

Vendor Registration Information Form

Organization*

Contact Person*

Address*

Phone Number*

E-Mail Address*

Type Of Service Provided*

Additional Information

Exhibitors Fees:

Non-Profit Vendors Please bring $50.00 Door Prize
Other Vendors $200.00

 

Please register no later than June 28th, 2019

Please make checks payable to: Out of the Dark Inc
818 E. Matthews Ave. Jonesboro, AR 72401
Table & chairs provided*. *IF you will require more space, please note that in the “Additional Information” text box provided in the Vendor Registration Information Form to the left.

For more information please contact:
Noelle Richardson, Drug Free Communities Coordinator
E-mail: noelle@outofthedark.org
Phone:(870) 917-5066

Please Click Here to download the conference registration form.  The form must be filled out, signed and then mailed to:
Out of the Dark Inc Office
818 E Matthews
Jonesboro AR 72401

OR

by email to noelle@outofthedark.org.

Participant Registration Information Form

Your Name*

Street Address*

City*

State*

Zip*

Phone*

Email Address*

T-Shirt Size*

**In order to keep the focus for everyone we ask that no children be in attendance. We are not able to provide daycare on site.**

Please note: there is a $25.00 per person fee to participate in this Conference that will cover meals, drinks and all activities offered. The fee is due at the time registration form is submitted. You will be directed to our secure PayPal payment page so you can make your $25.00 payment once you click on the "SUBMIT" button.

Each participant MUST read and accept the Terms below.

Waiver of Release and Liability:

I hereby waive all claims against, Out of the Dark Inc, sponsors or any personnel for any injury that I might suffer in this event. I attest that I am physically fit and prepared for this event. I grant full permission for organizers to use photographs of me and quotations from me in legitimate accounts and promotions of this event.

Please list any medical issues or allergies that you have that we should be aware of: