2024 Registration - Vendors, Educators, Owner, Trades, Guests

WWW.POWERUPLOUD.ORG

Higher Education, Training Organization,

Trade Association, Vendor, Contractor,

Suppliers, Industry Owners and Guests

please complete this form

Registration Form

It's A Mother-Daughter Thing! 2024

DATE: MARCH 12, 2024 TIME: 5:30 PM

LOCATION: BIRMINGHAM, ALABAMA

3500 6TH AVENUE SOUTH

BIRMINGHAM, AL 35222

*Please fill out the form to confirm you/your organization would like to participant.
*Event sponsors of $1000 and above may submit logo for event print/digital material
[upload jpg or pdf logo file on the application or send via email to 
wepoweruploud@gmail.com] 
*A Power UP Inc. representative will follow up with a courtesy call on additional 
event details. 

Thank you in advance for helping us make this event a success!

Name. [first name, last name]*

First Name

Last Name

Company / Organization's Name

Contact Phone Number*

Email*

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Participating Vendors, Educators, Supplies, etc - must submit the type of Activity or Display that you / your organization will provide at the event [layout, tables, tools, safety-PPE, Outlet, etc.]

this information is required for floor layout

Media Release Authorization Signature (Use your mouse or finger to draw your signature)*

[clear]

RELEASE FORM Consent Form For The Use Of Photographs And Videos (all participants including parent & children) Power UP Inc. recognizes the need to ensure the welfare and safety of all individuals taking part in all activities associated with our organization. We request your consent to take photographs/videos of the event or activity that may contain images of you. It is likely that these images may be used for the following purposes: • a record of the activity or the event •in a written evaluation report of the activity or event that will be viewed by Power UP Inc. and its Board of Directors • publicity material for future activities or events on advertisement materials • illustrations of the activities or events in published articles • future grant applications. Power UP Inc. will take all steps to ensure these images are used solely for the purposes they are intended. If you become aware that these images are being used inappropriately you should inform Power UP Inc. immediately. No compensation will be given for the use of any images. I consent to Power UP Inc. photographing or videoing as he/she will be taking part in the Power UP Inc. events.

Estimated number of organization's representatives attending the event

this information will assist us on floor layout

Sponsors may upload business logo for sponsorship materials

No File Chosen

File uploads may not work on some mobile devices.

Provide supporting document for company recognition for event donation and/or support

List any accommodations your institution/organization will require for the event

How did you hear about this event?

Friend or colleague Search Engine Advertisement Power UP Representative

Other:

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