BUYER PRE-REGISTRATION FORM

Badge Requests received by June 15, 2004 will be mailed to you prior to the show. After June 15, badges may be picked up on-site at "Will Call."

Two forms of proper business credentials required. Credentials may be a business card clearly stating your status as a retail owner, manager or buyer and a copy of your company business license or tax certification.

Fields marked with * are required.

First Name:*
Last Name:*
Company Name:*
Company Street Address:*
City:*
State/Province:*
Zip Code:*
Country:

Phone Number:*
Fax Number:*
Email Address:
Web Site Address:

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What is your job title?* Please Select... Owner Buyer Merchandise Manager Store Manager/Personnel Family Member

What is your product type?* (select all that apply)
Men's Shoes Women's Shoes Children's Shoes
Handbags/Accessories Apparel

What is your type of business?* Please Select... Retail Store - single location Retail Store - multiple locations Department Store/Specialty Chain Import/Export Distribution Web-Based Sales Non-Exhibiting Manufacturer Non-Exhibiting Supplier Other
If "Other":

What is your retail price point?* (select all that apply)
Discount Budget Moderate
Upper Moderate High End

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Once you have completed this form, please print it out by selecting the "print" button on your browser. Then fax or mail it along with your proper business credentials to:

WSA Registration Headquarters
PO Box 52170
Irvine, CA 92619

or Fax: (949) 475-1765

Thank you for registering for the upcoming WSA Show!

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