PBI Annual Conference EXPO Table Fee Payment Form

Organization Information

Organization Name

Organization Name Listing (if different than above)

If different than above, please enter organization name as it should appear in Annual Conference promotional materials.

Website / URL

Organization Description

Please provide a short blurb about your organization's mission and pro bono initiatives (500 word limit), important organization resources (1-5 linked resources), and additional pro bono information that you would like highlighted to further promote the important work you do. These features will allow Conference attendees to learn more about your mission and impact, even before the event begins. You can also email this information to gtimm@probonoinst.org by Monday, January 12.

Organization Processing First

Contact Information

Primary Contact Name

First

Middle

Last

Informal First Name/Nickname

Primary Contact Job Title

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email Address

Additional Contact Email

Additional Contact Name

First

Middle

Last

Additional Contact Job Title

Additional Contact Phone

Payment

Conference Year

EXPO Table Fee

Price: $50.00

Increase impact

Add 2% to Table Fee to help cover credit card processing fees.

Credit Card Processing Fee

Price: $0.00

Coupon

Total

$0.00

Stripe Credit Card