Name:
(As it should appear on your badge)
Title:
Company Name:

Company Address:    

City:
State/Province:
Zip/Postal Code:
Country:
Corporate Telephone:
Corporate Website:

Your Address:
(Company address if different from above) 

City:    
State/Province:
Zip/Postal Code:
Country:

Your Direct Telephone:


Your Fax:

Your E-mail Address:    


Trade Class:
(Check all that apply)		   My Product Interests:
(Check all that apply)
Supermarket Chain
Dry Grocery (Canned Foods; Sauces; Spreads; Dressings & Oils; Seasonings; Snacks; Chips; Cookies; Crackers; Gourmet & Specialty Foods; Organic & Health Foods)
Food Wholesaler Beverages (Soda; Juice & Other Non-Alcoholic Beverages)
Drug Chain Bakery
Drug Wholesaler Dairy
Mass Merchandiser/G.M./Discount Chain Frozen
General Merchandise Wholesaler Deli & Fresh Prepared
Membership Warehouse Club Meat & Poultry
Dollar Store Chain Seafood
Convenience Store Chain Produce (Vegetables; Fruits; Bagged Salads; Organic Produce)
Closeout Store Wine, Beer & Spirits
Department Store OTC & Health Care
Specialty Chain Hair & Skin Care, Beauty Products
Home Center/Hardware Chain Baby & Children's Products (Formula & Food; Baby Care; Diapers; Accessories & Supplies)
Pet Store Pet Food, Accessories & Supplies
Home Office Chain Household, Kitchen & Laundry Products (Cleansers & Fresheners; Paper Products; Plastic; Foils & Wraps; Insecticides)
Housewares Chain Housewares & Cookware (Baking; Tabletop; Food Preperation & Storage; Cleaning Aids; Small Electrics; Home Textiles; Decorative Accessories; Storage & Organizers; Lawn & Garden)
Military/Institutional General Merchandise (Stationery; Office & School Supplies; Consumer Electronics; Seasonal & Gift Wrap; Batteries; Tobacco & Lighters; Film & Cameras; Sun & Reading Glasses; Candles; Light Bulbs; Flashlights; Charcoal; Hosiery & Apparel; Crafts; Toys & Playthings)
Food Service Hardware & DIY (Paint & Decorating; Hand & Power Tools; Auto Aftercare; Tapes & Adhesives)
Catalogue Services (Packaging; Design & Graphics; Quality Assurance & Control; Strategic Planning; Software & Technology; Financial; Marketing & Market Research)
Internet Retailer
Other: (Please Specify)
Other: (Please Specify)
    

This registration form can be used by full-time employees of retailers and wholesalers.  All other registrants including manufacturers, suppliers, distributors and brokers should contact PLMA for the appropriate registration form.


Private Label Manufacturers Association
630 Third Avenue, New York, NY 10017   Telephone: (212) 972-3131   Fax: (212) 983-1382