In the threat of severe weather, fire, auto, or home accidents

Being safe is everything!

I hereby apply for acceptance into the 2016 ABC16/FOX24 SAFETYCON EXPO AND MARKETPLACE. I understand the event
will be held on April 2, 2016. I have read fully and understand the rules and regulations pertaining to this show and shall
abide by them.

Signature: ______________________________
**PLEASE PRINT CLEARLY**
CONTACT NAME __________________________________________________________________
NAME OF BUSINESS ______________________________________________________________
ADDRESS _______________________________________________________________________
CITY ________________________________ ST _____________________ ZIP ________________
TELEPHONE _____________________________________ FAX _____________________________
ALT. TELEPHONE _________________________________ EMAIL ___________________________
BUSINESS TYPE __________________________________ WEBSITE ________________________

Booth Size

10x10 ($350)

Sub-Total

10x20 ($600)

$___________

Sponsorship Level

Zone ($3,000)

Stage ($5,000)

Additional Items
_____________________
_____________________
_____________________
_____________________
110V Electricity

Cost
$________/each
$________/each
$________/each
$________/each
$60/each

Presenting ($7,500)
Quantity
_______
_______
_______
_______
_______

Less Deposit
$____________

$_____________
$_____________
$_____________
$_____________
$_____________

Balance Due
$___________

One table, table draping are included with booth space.

Special accommodations available upon request.

Payment in full must be received by March 18, 2016. $200 non-refundable deposit must accompany this
application.
PLEASE SUBMIT TO
WGXA-TV * Joanna Hemleb * 599 MLK Jr. Blvd., Macon, GA, 31201