* 1. Exhibiting Organization Name

* 2. Organization mailing address (address, city, st., zip)

* 3. Organization web address

* 4. Name of person(s) staffing exhibit table (need this for name badges). So include all that you want to appear on the name badge inlcuding title and credentials.

* 5. Email address of main person staffing exhibit table

* 6. Phone number of person staffing exhibit table

* 7. Name of person making arrangements.

* 8. Email of person making arrangements

* 9. Phone number of person making arrangements

* 10. Brief description of the products that will be displayed

* 11. Provide approximaltey how many people will be staffing your booth.

By completing this online agreement you are bound by the refund and cancellation policy.

Written (email) cancellations must be received by March 10, 2018 in order to be issued a refund less a $150.00 administrative fee. No refunds will be granted after this date. Cancellations will not be accepted over the phone. Refunds will be processed following the conference. The conference hosts reserve the right to substitute speakers or cancel and reschedule sessions due to any unforeseen circumstances.

The UTHSCSA School of Nursing federal tax identification number is 741586031. Exhibitor shall be fully responsible to pay for any and all damages to property owned by the University, which results from any act or omission of Exhibitor. Exhibitor agrees to defend, indemnify and hold harmless the University, its owners, managers, officers or directors, agents, employees, subsidiaries and affiliates from any damages or charges resulting from or arising from or out of or by reason of any accident or bodily injury or other occurrences to any person or persons, including the Exhibitor, its agents, employees and business invitees which arise from or out of Exhibitor’s occupancy and/or use of the exhibition premises, the University or any part thereof. The Exhibitor understands that the University does not maintain insurance covering the exhibitor’s property and that it is the sole responsibility of the Exhibitor to obtain such insurance.

* 12. What are you reserving?
Please review the prospectus before making your selection.

* 13. Payment Type:

* 14. We will send you and invoice no later than 5 working days.  Provide us the email and name of the person the invoice should go to.