VENDOR FORM FOR CONFERENCE September 22 - 24, Moline, IL

Name

Company

This address will receive a confirmation email

Phone

Address

Need Electricity?

Yes No

Description of Services or Goods Offered:

I have read and agree to the terms listed here: https://www.greatlakesunity.com/sites/greatlakesunity/files/2025-07/GLR%20Conference%20Vendor%20Form.pdf

YES

Payment (drop down menu)

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please read the vendor agreement here
https://www.greatlakesunity.com/sites/greatlakesunity/files/2025-07/GLR%20Conference%20Vendor%20Form.pdf

and then return to this fillable form.

VENDOR FORM FOR CONFERENCE September 22 - 24, Moline, IL

Description

Please Fix the Following