WIAAP Exhibitor/Supporter Application Athlete 360° - November 11, 2022, 2022 Thank you for your participation in WIAAP's 2022 Open Forum. We encourage you to promote the conference in your networks! Information and conference registration can be found at athlete360.eventbrite.com and our website at wiaap.org. Register via this link: athlete360.eventbrite.com. Please have each booth staff member register via that link to ensure we have nametags, food counts and any specific needs or accommodations. Please contact Rishelle Eithun, reithun@wiaap.org, 608.395.9368, with any questions. (WIAAP's tax ID is #31-1535272; certificate available by request.) OK Question Title * 1. Primary contact information Contact Name Organization Name Billing Address Address Line 2 (optional) City/Town State/Province ZIP/Postal Code Email address Cell phone number OK Question Title * 2. Level of support Forum Champion ($4,000) Forum Collaborator ($2,000) Forum Supporter ($1,000) Forum Advocate ($500) OK Question Title * 3. Credit card information (Visa/MC, American Express) Name on card (if different from primary contact name) Card number Expiration date XX/YY CVV / Security Code Billing address: OK Question Title * 4. Checks - mail to WIAAP, PO Box 243, Oconomowoc, WI 53066 (include check number, if available). OK Question Title * 5. Contact for promotional/artwork needs (name and email address) OK Question Title * 6. Do you require any other accommodations? OK DONE