I, (Print Name) _______________________________________________________________________

Authorized Representative of (Company Name) _____________________________________________

HEREBY AUTHORIZE EASTERN TRAVEL ASSOCIATION TO CHARGE MY CREDIT CARD IN THE AMOUNT OF $775.00 ($725.00 if paid before May 15, 2009 and a vendor from the 2008 show) or $800.00 if paid after July 31, 2009.

$_________________________. This represents payment for the ETA TRADE SHOWS, November 16, 17, 18, 2009.

I agree to the terms and conditions of the Trade Show Terms.

CREDIT CARD INFORMATION: (please circle one)      VISA,    MASTERCARD,     AMERICAN EXRESS 

CREDIT CARD NUMBER: ____________________________________________________

EXPIRATION DATE: ___ ___ / ___ ___        SECURITY CODE: __________

SIGNATURE

_________________________________________________       DATE: ___________________________

BILLING ADDRESS:

_________________________________________________________________________

_________________________________________________________________________

PHONE:   _________________________________________________

Tax ID: 23-2636583

Please Fax or Mail this form to:

Eastern Travel Association
Jim Verano, Treasurer
PO Box 42
Clarks Summit, PA  18411

FAX:  570.586.7819