Registration: 2017 Convention Sponsor Registration

 Please complete all areas of this form to ensure proper registration.

A $100 late fee will be included if registration is received after September 25.

USER INFORMATION
First Name:
Last Name:
Organization:
Address:
Address 2:
City:
State:
Zip:
Phone:
Email:
Confirm Email:
Will the Primary Representative be attending the Convention?:
Yes  No  
If you answered "no" please list names of representatives attending:
Will you need electricity:
Yes  No  
Sponsor Opportunities:
Lunch Sponsor + 1 Full Conv. Tabletop ($1,500)  
Breakfast Sponsor + 1 Full Conv. Tabletop ($750)  
Session Sponsor + Full Conv. Tabletop ($710)  
Session Sponsor + 1 Thursday Only Conv. Tabletop ($697.50)  
Session Sponsor - No Tabletop ($500)  
If you selected a sponsorship that includes tabletop space, please note that the selections below would be in addition to the space already detailed in your sponsorship.
Additional Sponsor Opportunities:
1 Thursday Only Tabletop Display ($395)  
2 Thursday Only Tabletop Displays ($790)  
1 Full Convention Tabletop Display ($420)  
2 Full Convention Tabletop Displays ($840)  
Convention Marketing Opportunities:
Bags for Attendees ($250)
Folders for Attendees ($250)
Notepads for Attendees ($250)
Convention Packet Inserts ($100)
Marketing Lists ($100)
Do you plan to participate in the CE session:
Yes  No  
If you're planning to donate an item for a door prize, please list item here:
Thursday Meal Tickets ($20 each):
Friday Meal Tickets ($20 each):
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