United Shoe Retailers Association
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Retail Application

RETAILER

VENDOR

United Shoe Retailers Association

MAY EVENT RETAIL APPLICATION

USRA May Event 2012 - May 1, 2, & 3

Company Name:
Website:
Address:
City/State/Zip*:
Phone:
Fax:
President/Owner
General Manager
Manager
Other
Your Name:
Email:

If different than company numbers:

Your phone:
Your Fax:
Arrival Date:
Departure:
Spouse
Sibling
Child
Parent
Friend
Co-Worker
Title:
Name:
Email:

If different from Attendee #1:

Address:
City/State/Zip:
Phone:
Fax:


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United Shoe Retailers Association

MAY EVENT RETAIL APPLICATION

USRA May Event 2012 - May 1, 2, & 3

Company Name:

Single Occupancy
Non-Smoking
King
Double Occupancy
Smoking
Two Doubles
**Saturday (04/28/12) Arrival - an additional $189 plus tax will apply
**Sunday (04/29/12) Arrival - an additional $189 plus tax will apply
**Monday (04/30/12) Arrival - an additional $189 plus tax will apply
**Friday (05/04/12) Departure - an additional $189 plus tax will apply


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United Shoe Retailers Association

MAY EVENT RETAIL APPLICATION

USRA May Event 2012 - May 1, 2, & 3

Company Name:

$395 May Event 2012 Retail Fee
YES!! SIGN ME UP AS A USRA MEMBER
         PLEASE ADD THE $95 MEMBERSHIP FEE & I’LL PAY MEMBER PRICES!!
$490 May Event 2012 + USRA MEMBERSHIP
         Membership = $95 per Membership Year (9/30-10/1)


Total Enclosed$
Check payable to:
USRA
Mastercard
Visa
Amx
Name:
Card Number:
Exp Date:
Security Code:
On Visa, MasterCard and Discover the security code is the three digits to the right of the credit card number in the signature area on back of the card.    On American Express, the security is four digits printed (not embossed) on the right front of the card above the credit card number.
Credit Card Billing Address:
Same as listed above
See Below


Address:
City/State/Zip*:

For early arrivals/late departures credit card must be on file. It will not be charged unless you do not cancel in advance. NON CANCELLATIONS WILL BE CHARGED BY THE HOTEL


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United Shoe Retailers Association

RETAIL: May Event Application

Company  
Year Opened     Years Family Owned  

Please complete the following: (Check all that apply)

LOCATION
Strip Center    Indoor Mall    Freestanding    Lifestyle Ctr    Online

NUMBER of STORES
Single Store    Multiple Stores    # of locations

STORE TYPE
Men's    Women's    Website    Specialty   
Children's    Family    Orthopedic    Concept

PRODUCT TYPE
Comfort    Fashion    Dress    Athletic   
Work    Orthopedic    Designer    Medical

RETAIL PRICE POINT
Low to moderate (up to $50)   Moderate ($50 - $150)
Moderate to High ($150-$300)   Over $300

Please include the names/dba's, address's, phone and fax of all additional locations on another sheet.

THANK YOU!!

 


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For early arrivals/late departures credit card must be on file.
It will not be charged unless you do not cancel in advance of the Event.
NON CANCELLATIONS WILL BE CHARGED BY THE HOTEL.

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