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2019 QCESC Banquet Pre-Registration for Displays
Organizations or individuals wishing to have a display during the social hour need to fill out this form and submit. With the social scheduled from 5:00 - 6:30 PM, you need to be setup no later than 4:45 PM.

The event is being held at the John Deere World Headquarters, One John Deere Place, Moline, Illinois.

Any further questions on displays should be sent to Sankari Kandasamy, QCESC STEM Coordinator via e-mail at sankarikandy@gmail.com.

Note: You must fill out all of the mandatory fields as indicated by a symbol * at the end of the field name (example Your Full Name *) for the form to ave saved and submitted.

Email address *
Your Full Name *
(Example John Smith)
Your answer
Phone Number (cell phone if available) *
(format XXX-XXX-XXX - would only use if can't reach by e-mail)
Your answer
Organization you Represent or None *
Your answer
Need Table Provided (~ 6' x 3') for Your Display? *
Need 120 Volt Electricity for you Display? *
Short Description of what you will have on Display with any questions or comments *
Your answer
A copy of your responses will be emailed to the address you provided.
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