First Name *

Last Name *

Company Name

Email *

Phone *

City *

State *

Are you an Artist or Vendor? *

Artist

Vendor

Website

Instagram *

Facebook

TikTok

1. Artist/Attendee government legal name (MAX OF 2 PER BOOTH) *

2. Artist/Attendee government legal name (MAX OF 2 PER BOOTH)

3. Artist/Attendee government legal name (MAX OF 2 PER BOOTH)

Payment method: Wire Transfer

BANK WIRE - Domestic & INTERNATIONAL

Financial Institution Name: TD Bank

Financial Institution Address: Wilmington, DE

Account Information

Routing: 067014822

Account: 4444258077

ABA: 031101266

Beneficiary Information

Customer Name: ALL STARS TATTOO CONVENTIONS LLC

Customer Address:

200 PARK CENTRAL BLVD S. STE 5, POMPANO BEACH FL, 33064

Swift Code (for international wires):

NRTHUS33XXX

Once registration form has been submitted and full payment has been confirmed, please provide All-Stars Tattoo Convention with your artist/vendor logo (eps, pdf or jpeg) and send to: allstars@dynamiccolor.com

*I understand that in order to practice ANY body arts at the All-Stars Tattoo Convention, I must have a valid and verifiable Tattoo Artist Practitioner license issued

by the Florida Department of Health. I also understand that if issued a guest license it is only valid during the requested datesto include All-Stars Tattoo

Convention event dates and not to exceed 14 days.

*I agree to comply with all the rules and regulations specified and set forth by the Florida Department of Health while practicing in the State of Florida.

Signature *

Clear

Date *

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