2012 Infant Toddler Symposium Exhibitor Application

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"Weaving the Tapestry of Quality Infant Toddler Care"
August 7-8, 2012
The River's Bend Conference Center of California University of Pennsylvania

To Submit an exhibitor application, please complete this form by July 10, 2012

Information for Exhibitor Directory:

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* 1. Company/Organization Name

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* 2. Company/Organization Address:

Address:

Address 2:

City/Town:

State:

ZIP:

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* 3. Phone Number

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* 4. Fax

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* 5. Email Address

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* 6. Website Address

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* 7. Products and services to be displayed (you must demonstrate a clear infant toddler focus)

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* 8. Contact Person to Receive Correspondence Regarding Exhibit Space

Name:

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

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* 9. Individuals that will be staffing the exhibit space

Staff #1

Staff #2

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* 10. I will donate the following item(s) for a door prize(s)

The Pennsylvania Head Start Association will assume on liability for loss or damage of goods or materials owned or leased by the Exhibitor.

PHSA reserves the right to restrict exhibits because of noise, method of operation or for any other reason that might detract from the character of the convention as a whole.

Your Exhibit fee entitles you to:
One 8' table with box skirting, one chair
List of attendees
Attendance at break-out workshops and professional development credits
Meal package for on exhibit staff member (additional meal packages may be purchased separately for a cost of $50 each)
Listing in the exhibitor directory of the conference program

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* 11. Tables

One For Profit Table at $250

Second For Profit Table at $250

One Non Profit Table at $150

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* 12. Meal Packages Needed: Your table fee entitles you to one meal package/table. Additional packages can be purchased for $50/package.

I require one meal package included in my table fee

I would like to purchase an additional meal package at $50 for a total of 2 meal packages

I would like to purchase 2 additional meal packages at $50 for a total of 3 meal packages

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* 13. Electricity

Yes, I will need electricity for my exhibit at $10.00

No, I will NOT need electricity for my exhibit

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* 14. Total Exhibitor Fee

Final Table Fee

Final Additional Meal Packages

Final Electricity

Total Fee

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* 15. Please send payment to PHSA, 3700 Vartan Way, Harrisburg, PA 17110
For billing purposes, you must provide one of the following:

Social Security Number

Tax ID Number

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* 1. Company/Organization Name

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* 2. Company/Organization Address:

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* 3. Phone Number

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* 4. Fax

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* 5. Email Address

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* 6. Website Address

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* 7. Products and services to be displayed (you must demonstrate a clear infant toddler focus)

Question Title

* 8. Contact Person to Receive Correspondence Regarding Exhibit Space

Question Title

* 9. Individuals that will be staffing the exhibit space

Question Title

* 10. I will donate the following item(s) for a door prize(s)

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* 11. Tables

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* 12. Meal Packages Needed: Your table fee entitles you to one meal package/table. Additional packages can be purchased for $50/package.

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* 13. Electricity

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* 14. Total Exhibitor Fee

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* 15. Please send payment to PHSA, 3700 Vartan Way, Harrisburg, PA 17110For billing purposes, you must provide one of the following:

* 15. Please send payment to PHSA, 3700 Vartan Way, Harrisburg, PA 17110
For billing purposes, you must provide one of the following: