Indiana Environmental Health Association
INDIANA ENVIRONMENTAL HEALTH ASSOCIATION
2016 Fall Educational Conference Exhibitor Form
Blue Chip Stardust Event Center
777 Blue Chip Drive
Michigan City, IN 46360
September 26-28, 2016
Please Print:Please Respond by: August 1, 2016
Organization/Exhibitor:
Address:
(address)(city)(State) (zipcode)
Contact:Telephone No.:
Conference Attendees:
Email Address:
Check all that is applicable: / Yes / No / CostBooth Space including 6’ X 30” table, tabletop cover, 2 chairs, wastebasket / $300.00
Electrical Outlet. Do you need an extension cord? (in addition to booth space & table) / $ 15.00
**Conference Registration at “Member” rate. (Includes 3-breakfast buffets, 2 lunches, 2 dinners, break & entertainment.) / $205.00
**If registering for the conference, please answer the following questions: / Yes / No
Do you require vegetarian meal(s)?
Do you plan to play golf on Sunday, September 25th? (12:30 lunch; 1pm tee time) (cost on your own. Complete Golf Form)
Plan to attend Bed Bug Pre-conference Workshop on Sunday, September 25th? If yes, RSVP to link at
(12pm – 5:30pm)
Plan to participate in the Bicentennial Beach Walk on Sunday, September 25th? (2:30pm-:4:30pm)
Plan to attend the Value-added Speaker session on Sunday, September 25th? (6:30pm – 8pm) (at Event Center)
Plan to attend the Bicentennial Mix & Mingle on Sunday, September 25th? (8pm-10pm) (at Event Center)
Are you attending the Awards Banquet on Monday, September 26th? (dress is semi-formal – coat & tie) (at Event Center)
Plan to participate in the Wastewater Field Trip on Tuesday, September 27th? (1:30pm-4:30pm) (off-site)
Plan to attend the lakefront dinner on Tuesday, September 27th? (5:30pm-7pm)
Concurrent Sessions you plan to attend: ___LHD Adm.(Mon.only) ___Foods ___Gen. Env. ___ Terror & All Hazards ___Wastewater
Make Payment Payable:2016 IEHA Fall Educational Conference
Mail Payment and Form to: Indiana Environmental Health Association, Inc.
(Fax form to Tami Barrett)P.O. Box 457 Indianapolis, IN 46206-0457
317-797-3255 (cell) OR 317-233-7387 (fax)
Conference Lodging & Location: Same as above. Special room rates at $89.00 (Blue Chip Tower) or $109.00 (Spa Tower) must be made by September 4, 2016. After that date or IF room block is full prior to that date, reservation rates will be subject to current available rates. To book a room, call 888.879.7711 and press #2 for reservations. The Group Code is GEH0918 or IEHA Fall Conference. The Spa Tower rooms are nearest the event center and reservation desk. Blue Chip Tower rooms are a short indoor walk to the event center and reservation desk.
Set-up: Drive to Event Center entrance (follow sign) between 2pm-8:00pm on Sunday, September 25; check-in & then park.
Parking is free-valet, lot or garage.
Exhibiting does not imply endorsement of products or services by the Indiana Environmental Health Association.
This is for educational purposes only.
Total Amount Remitted: _$______