P.O. Box 12359

Norfolk, VA23541

Hampton Roads Case Management Society

6th Annual Fall Conference

October 13, 2012

Exhibitor Registration Form

The HRCMS appreciates your financial support which represents the major funding for our annual meeting and conference. Your contributions help offset the cost of providing quality speakers and other materials for attendees. All of your donations are greatly appreciated. Please choose from the category list that best suits the value of your donation.

In recognition of your donation, the HRCMS will provide the following:

Platinum above $2,500 & door prize
One exhibitor booth in prime location
including two tables for display
4 Luncheon tickets and Certificate of
Appreciation presented during Luncheon
Full page ad in program
Corporate Logo Displayed on HRCMS website
Recognition at registration table
Your banner to be displayed prominently
Special sponsor recognition name tags / Gold $2,500 & door prize
One exhibitor booth in prime location
Bitorincl including one table for display
3 Luncheon tickets and Certificate of
Appreciation presented during Luncheon
Full page ad in program
Corporate Logo Displayed on HRCMS website
Recognition at registration table
Your banner to be displayed prominently
Special sponsor recognition name tags
One exh
Silver $1,000 & door prize
One exhibitor booth, including one table for display
2 Luncheon tickets and Certificate of
Appreciation presented during luncheon
½ page ad in program
Recognition when door prizes are awarded
Special sponsor recognition name tags / Exhibitor $500 & door prize
One exhibitor booth, including one table for display
1 Luncheon ticket
Acknowledgement in the program
Recognition at registration table
Special sponsor recognition name tags

Please check the box indicating the value of your donation:

Platinum

Gold

Silver

Exhibitor

Charitable

Note:

HRCMS reserves the right to record video and take photographs for promotional and educational purposes.

Person representing your organization or company:

______

Organization Name and Address:

______
______

Name of Attendant and Attendee(s): ______

______

Phone Number(s): ______

Business Cell

Additional luncheon tickets can be obtained at the expense of the contributor.

How many additional lunch tickets will you be purchasing? ______

If you have any questions please feel free to contact:

Millie McNally, Chair @ (757-660-5738), or Rita Scott, Co-Chair, @ (757-303-4438) HRCMS Annual Conference Educational Committee

Return this form by June 30th completed with checks made payable to:

Hampton Roads Case Management Society

Attn: Annual Conference Educational Committee

P. O. Box 12359

Norfolk, VA23541