GCDC

Company Name:*
Your Name:*
Your Phone#:*
Your Email:*
Co-Host Name:*
Co-Host Phone:* ext
Co-Host Email:*
Other Contact Info:
Hosting Type:*
GCDC Event Confirmation#:*
Shipping Information
Attention:*
Address:*
City:*
State:*
Zip:*
How Many Participants are you expecting?:*
How many participants are registered to date? :*
Event Location (Describe):*
Link to Event Registration Page:*
How are you promoting your event?:*
Are you currently a retailer of Bumkins?*:
Would you be interested in retailing Bumkins?*:
Other Comments: