If you wish to charge your exhibit cost or sponsorship to Mastercard or Visa, complete the form below and return it to:

       Denise Smith

       Stanton County Public Library

       P.O. Box 480

       Johnson, Kansas 67855

KANSAS LIBRARY CONFERENCE

2010

Mastercard                 Visa

○                          ○

Account#_________________________________________               

Cardholder Name__________________________________

Expiration Date____________________________________

Authorized Signature_______________________________

Company Name___________________________________

Date_______________

Amount________________