4th Annual

Sponsorship and Exhibitor

Opportunities

New Date! Thursday, October 12, 2017

Location: University of Southern Indiana, University Center, Evansville

HPR870A

Organization Name
Address
City /State/Zip
Contact Name
Email
Telephone Number
Names of persons attending the booth
Please Check
CORPORATE SPONSOR $ 1,000
*Your corporate name and logo on all publicity materials, including brochure and conference webpage.*Prime exhibit location. *Two registrations to the conference. *Special signage in University Center. *Special recognition during opening session.
__ EXHIBITOR $ 300
Six foot table with tablecloth. *Program acknowledgement. * Company web site link on our conference webpage *One full registration to the conference.
Booth includes: One 6' clothed table and two chairs.
*Please note that outside food may not be brought in and distributed at your exhibit table; wrapped candy is acceptable.
_____Electricity requested for exhibit.
(Limited availability. Request in advance of event)
PAYMENT –Make payment within 21 days of registration
qCheck (Make checks payable to: USI) USI Tax ID number: 351308176
Credit Card: q VISA, qMASTERCARD q DISCOVER qAMEX
Card #:
Exp. Date: ____/____ Credit Card Billing Zip Code:
Name on Card: Security Code:
Billing Address: (if different from address given above):
Please complete the information below for mobile app advertising opportunities
*Organization Name
*Address
*City /State/Zip
*Company URL / Phone

Sponsorship opportunities will be accepted until all places are filled, or October 12, 2017 whichever occurs first. NO exhibit registrations will be accepted by phone or email without this completed Sponsorship and Exhibit Opportunities Registration form. Confirmation of your registration will be mailed to you. If your check is not received within 21 days of the confirmation, we will open up the exhibit location for others requesting space.

Usi.edu/health

RETURN by 07/21/17 for inclusion in conference brochure, where applicable

TO: Jennifer Hertel, 8600 University Blvd, Evansville, IN, 47712 • • Fax: 812-465-7061 • Phone: 812/461-5463