Business Name (*)
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Primary Contact First Name (*)
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Primary Contact Last Name (*)
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Email Address (*)
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Street Address (*)
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Suite
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City (*)
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State (*)
Please select one NOT IN THE USA Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Invalid Input
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Country (*)
Please select one United States Canada Akrotiri Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Arctic Ocean Argentina Armenia Aruba Ashmore and Cartier Islands Atlantic Ocean Australia Austria Azerbaijan Bahamas, The Bahrain Baker Island Bangladesh Barbados Bassas da India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Coral Sea Islands Costa Rica Cote d Ivoire Croatia Cuba Cyprus Czech Republic Denmark Dhekelia Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia, The Gaza Strip Georgia Germany Ghana Gibraltar Glorioso Islands Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Howland Island India Indian Ocean Indonesia Iran Iraq Ireland Israel Italy Jamaica Jan Mayen Japan Jarvis Island Jersey Johnston Atoll Jordan Juan de Nova Island Kazakhstan Kenya Kingman Reef Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Man, Isle of Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Midway Islands Moldova Monaco Mongolia Montserrat Morocco Mozambique Namibia Nauru Navassa Island Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pacific Ocean Pakistan Palau Palmyra Atoll Panama Papua New Guinea Paracel Islands Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia Southern Ocean Spain Spratly Islands Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tromelin Island Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands Wake Island Wallis and Futuna West Bank Western Sahara Yemen Zambia Zimbabwe Invalid Input
Postal (zip) code (*)
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Fax Number
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Main phone # (*)
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Secondary Contact First Name
Secondary Contact Last Name
Secondary phone #
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Secondary Email Address
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Website
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Club Furnishings Carpet Furniture Rails, racks, fixtures Signage Specialty items, artwork Invalid Input
Other
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Club Products Air purification Apparel & promo items ATM Beer, liquor, beverages Boutique Products/ Novelties Food prep equipment Gaming equipment Glassware, bar products ID/age verification Liquor control systems Music products & equip. Security systems Tobacco products Vending equipment Invalid Input
Other
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Club Services Accounting & financial Advertising Architects Associations & organizations Club management Franchising, licensing Insurance Legal Invalid Input
Other
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Entertainer Products Dancewear & shoes Promotional material Skin, beauty products Invalid Input
Other
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Entertainer Services Agencies & professional services Medical services Invalid Input
Other
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Media Web & internet services Photographer/Videographer PR Agency Print publication Print services Invalid Input
Other
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Production Lighting Sound Staging Special effects Invalid Input
Other
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Company Description Invalid Input
Include a listing on your company in the Annual PREFERRED VENDORS GUIDE? (*)
YES no Invalid Input
Start your complimentary subscription to receive the bimonthly ED Club Bulletin? (*)
YES no Invalid Input
Call you when your business category is part of a Special Editorial Focus in ED Club Bulletin? (*)
YES no Invalid Input
Contact you about special Big-Discount frequency advertising programs? (*)
YES no Invalid Input
Contact you about exhibit space at the 2012 Gentlemen’s Club Owners EXPO Tradeshow? (*)
YES no Invalid Input
Contact you about banner placement on EDpublications.com and/or ExoticDancer.com? (*)
YES no Invalid Input
"We have achieved a major industry milestone with the 20 years of EXPO event." The Annual EXPO is the most beneficial convention in the Adult Club Industry. 
