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Exhibitor Registration Form

 

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1. Company Information

Company Information   Name:
Company:
Address:
Address 2:
City/Town:
State:	-- select state --AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming
ZIP/Postal Code:
Web Site:
Email Address:
Phone Number:

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2. Company Contact (pre-show contact for vendor correspondence)

Company Contact (pre-show contact for vendor correspondence)   Name:
Title:
Organization:
E-mail:

3. Corporate Partner Booth Reservation (eligible 2012 partners)
All booths are 8' x 10' with black and white 8' backwall and 3' sidewall draping & include one 8' skirted table, identification sign, 2 chairs, a wastebasket & one 110v electrical outlet.

Corporate Partner Booth Reservation (eligible 2012 partners) All booths are 8' x 10' with black and white 8' backwall and 3' sidewall draping & include one 8' skirted table, identification sign, 2 chairs, a wastebasket & one 110v electrical outlet.   $375, one booth, Early Bird (payment & signed contract received by 01/05/12)

$525, 2 booths, Early Bird (payment & signed contract received by 01/05/12)

$425, one booth, (payment & signed contract postmarked by 02/16/12)

$725, 2 booths (payment & signed contract postmarked by 02/16/12)

$600, one booth, (payment & signed contract postmarked after 02/16/12)

4. Non-Corporate Partner Booth Reservation
All booths are 8' x 10' with black and white 8' backwall and 3' sidewall draping & include one 8' skirted table, identification sign, 2 chairs, a wastebasket & one 110v electrical outlet.

Non-Corporate Partner Booth Reservation All booths are 8' x 10' with black and white 8' backwall and 3' sidewall draping & include one 8' skirted table, identification sign, 2 chairs, a wastebasket & one 110v electrical outlet.   $450, one booth, Early Bird (payment & signed contract received by 1/05/12)

$600, 2 booths, Early Bird (payment & signed contract received by 1/05/12)

$500, one booth, (payment & signed contact postmarked by 02/16/12)

$825, 2 booths, (payment & signed contract postmarked by 02/16/12)

$700, one booth, (payment & signed contract postmarked after 02/16/11)

5. Innovation Theater Companies can purchase 15-minute time slots for presentations on Thursday, May 3rd on new products or services. (Limited slots available)

Innovation Theater Companies can purchase 15-minute time slots for presentations on Thursday, May 3rd on new products or services. (Limited slots available)   $100, Corporate Partner, Early Bird (payment & contract received before 1/05/12) $150, Corporate Partner, (payment & contract received by 02/16/12) $150, Non-Corporate Partner, Early Bird (payment & contract received before 1/05/12) $200, Non-Corporate Partner, (payment & contract received by 02/16/12)

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6. Enter the number of your booth selection. For available booths, go to the exhibit floor plan Exhibit Layout

Enter the number of your booth selection. For available booths, go to the exhibit floor plan Exhibit Layout

7. Description
Provide a description of your equipment, products or services for the final convention program (50 words or less)

Description Provide a description of your equipment, products or services for the final convention program (50 words or less)

8. My company would like to sponsor the events(s) selected below:

My company would like to sponsor the events(s) selected below:   "Wine Down" Party, Exclusive ($1500 Level) "Wine Down", Co-Sponsorship, ($1000 Level) Exhibit Opening Reception, Exclusive ($1000 Level) Exhibit Opening Reception, Co-Sponsorship ($500 Level) Keynote Speaker Sponsor, 2 Available ($500 Level) Volunteer Recognition Luncheon, Co-sponsorship ($500 Level) Student Education Scholarship, Multiple Available ($500 Level) Refreshment Breaks, Multiple Available ($250 Level) Attendee Name Badge Holders, ($250 Level) Exhibit Hall Game Prize, Multiple Available ($100 Level)

Other (please specify)

9. Please contact me to discuss sponsorship opportunities.

Please contact me to discuss sponsorship opportunities.   Yes

No

10. Advertising
My company wants to advertise in the convention program.

Advertising My company wants to advertise in the convention program.   Free, Quarter Page, for 2012 Corporate Partner $50, Business Card Ad $100, Quarter Page, Non-Corporate Partner $200, Half Page $400, Full Page

11. Do you want information about the benefits of the WHIMA Corporate Partnership program?

Do you want information about the benefits of the WHIMA Corporate Partnership program?   Yes

No

12. Payment Method
Payment by check or credit card will be accepted. An invoice and confirmation will follow via e-mail. Mark your payment option:

Payment Method Payment by check or credit card will be accepted. An invoice and confirmation will follow via e-mail. Mark your payment option:   Check - Payable to WHIMA Credit Card, Visa, MasterCard or Discover card only

13. Comments or Questions?

Comments or Questions?

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14. Acceptance
By inserting my name, our company agrees to abide by the Regulations for Exhibitors as printed separtely which are made part of this contract by reference to the contract on the WHIMA web site.

Acceptance By inserting my name, our company agrees to abide by the Regulations for Exhibitors as printed separtely which are made part of this contract by reference to the contract on the WHIMA web site.   Name:
Title:
Phone Number:
E-Mail: