2015 Fall Special Education Conference Exhibit Request Form

Question Title

* 1. Organization Contact Information:

Name: *

Company: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Email Address: *

Phone Number: *

Question Title

* 2. Representing us at the conference will be:

Name:

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

Representative 1:

Representative 2:

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* 3. Please reserve our company a booth. We request that the following number of booths be reserved:

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* 4. We will need an electrical outlet:

Yes

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* 5. We will provide a doorprize:

Yes

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* 6. Tell us how your exhibit relates to Oregon Special Education (200 words or less). If selected, we will put this information in the conference program.

If you are selected you will be billed $500 (per table) for the requested exhibit space.

COSA will not be responsible for the safety of the property of exhibitors from theft, damage by fire, water, storm, vandalism, or other causes, but will take reasonable precautions to protect the exhibitors from such loss.