CONFERENCE EXHIBITOR REGISTRATION FORM
ALL OPTIONS ARE OFFERED ON A FIRST COME, FIRST SERVED BASIS. REGISTER EARLY.
PLEASE COMPLETE THE ENTIRE FORM FROM STEPS 1-5. PLEASE TYPE OR WRITE LEGIBILY.
  1. Exhibitor Program Guide Listing
This information will be used verbatim for your listing in our conference program guide. Please double check your information and spelling.
Company Click here to enter text.
Website Click here to enter text.
Main Contact Name Click here to enter text.
Main Contact Email Click here to enter text.
Main Contact Phone Click here to enter text.
Product or Service Description [150 word max.] Click here to enter text.
  1. Exhibitor Booth Attendees
    Two Exhibitor Booth Attendees are included in the registration. If you would like to add additional attendees at the cost of $100 per additional person, please check the additional attendee box in the additional options section and include their information.
ATTENDEE #1
First Name Click here to enter text.
Last Name Click here to enter text.
Title Click here to enter text.
Email Address Click here to enter text.
Dietary Restrictions Click here to enter text.
ATTENDEE #2
First Name Click here to enter text.
Last Name Click here to enter text.
Title Click here to enter text.
Email Address Click here to enter text.
Dietary Restrictions Click here to enter text. /
2016ANNUAL CONFERENCE
2/27 – 3/1, 2017
Hilton Polaris
8700 Lyra Drive, Columbus, OH 43240
(614) 885-1600
HOW TO REGISTER:
ONLINE
EMAIL
Complete this form as a word document and email it to us at
______
PHOTO DISCLAIMER:
OACHC will be taking photos during the event and may publish them in any format or media without additional permission from you if you are in the photo.
For questions contact us at .
OACHC internal use:
Registered: ______
Paid Date: ______
Check #: ______
3. Registration Options
CORPORATE PARTNER PRICING / SPONSOR PRICING / EXHIBITOR ONLY
SPONSORSHIP
Sponsor Packages / Platinum / Gold / Silver / Bronze / Diamond / Deluxe / Exclusive
☐Diamond Level / $2500 / $2500 / $2500 / $2500 / $2500 / NA / NA / $2500
☐Deluxe Level / $2000 / $2000 / $2000 / $2000 / NA / $2000 / NA / $2000
Stand Alone Sponsorships
☐Raffle Prize Sponsor [2 Available] / $1000 / $1000 / $1000 / $1000 / $1000 / $1000 / $1000 / $1000
☐Lunch Sponsor [2 Available] / $1500 / $1500 / $1500 / $1500 / $1500 / $1500 / $1500 / $1500
☐Breakout Session Sponsor / $1000 / $1000 / $1000 / $1000 / $1000 / $1000 / $1000 / $1000
☐Board Reception Sponsor [1 Available] / $5000 / $5000 / $5000 / $5000 / $5000 / $5000 / $5000 / $5000
EXHIBIT BOOTHS / Platinum / Gold / Silver / Bronze / Diamond / Deluxe / Exclusive / EXHIBITOR ONLY
☐Prime Booth [Choice of location] / Included / Included / $500 / $900 / Included / Included / $1600 / $1600
☐Standard Booth [6’x3’ Table] / NA / NA / NA / NA / NA / NA / $1100 / $1100
☐Non-Profit Booth [6’x3’ Table] / NA / NA / NA / NA / NA / NA / $700 / $700
☐XXL Booth [Larger Area w/ Table] / $250 / $250 / $250 / $250 / $250 / $250 / $250 / $1250
4. Additional Options
CORPORATE PARTNER PRICING / SPONSOR PRICING / EXHIBITOR ONLY
BOOTH UPGRADES / Platinum / Gold / Silver / Bronze / Diamond / Deluxe / Exclusive
☐Electricity at Booth / Included / Included / Included / Included / Included / Included / $40 / $40
☐XL Booth [Larger Area w/ Table] / $250 / $250 / $250 / $250 / $250 / $250 / $250 / $250
PROGRAM GUIDE ADS
☐Full Page Ad / Included / Included / $1000 / $1000 / Included / $1000 / $1000 / $1000
☐Half Page Ad Vertical / $500 / $500 / Included / $500 / $500 / Included / $500 / $500
☐Half Page Ad Horizontal / $500 / $500 / Included / $500 / $500 / Included / $500 / $500
☐Quarter Page Ad / $250 / $250 / $250 / Included / $250 / $250 / $250 / $250
ADDITIONAL ATTENDEES
☐Additional Booth Attendee #3 / $100 / $100 / $100 / $100 / $100 / $100 / $100 / $100
☐Additional Booth Attendee #4 / $100 / $100 / $100 / $100 / $100 / $100 / $100 / $100
5. Payment MethodPayment MUST be within 30 days of registration or before the conference whichever occurs first.
Billing Address: Click here to enter text.
TOTAL AMOUNT DUE Click here to enter text.
☐ CREDIT CARD
OACHC Accepts Amex, Mastercard, Visa, Discover Credit Cards.
For security purposes please provide an email address that we can send a secure payment link toupon processing your registration.
Email for Secure Payment Link Click here to enter text.
☐ CHECK
Please mail check to:
2109 Stella Ct.
Columbus Oh, 43215
If name or company name on check doesn’t match registration, please include a copy of this registration form.