MPA Rural Conference Exhibitor/Sponsor Form

The 9th Annual Rural Behavioral Health Practice Conference, “Clinical Resources for Rural Practice,” connects a wide range of behavioral health providers across rural America, both by individual webcast and at group webcast sites. It is an opportunity to showcase mental health treatment providers, practice tools and resources and employee recruitment. We have a number of sponsor and exhibit options to help you get your information to webcast participants, as well as to in-person participants if you choose to exhibit in person at a group webcast site or the origination site in Morris, MN. We anticipate more than 200 participants. Visit see a full conference description.

Deadline for receiving all sponsor and exhibit materials:September 15, 2017.

Questions? Contact Conference Coordinator Kay Slama, PhD, at or 320-905-6051.

Benefits to Sponsoring and Exhibiting Organizations:

  • Leadership recognition among behavioral health providers across rural America
  • Marketing and recruitment opportunities
  • Webcasting your video materials or PowerPoint with voice/sound at 2-3 breaks in each time zone, with your contact information displayed prominently, so participants can contact you by phone or email. Your exhibit materials will also be on the conference document site, and you will receive recognition on the conference agenda. An Additional option is an onsite exhibit at your choice of origination site or in-person group webcast sites, but note that you need not be present at any particular site during the conference.

Conference Sponsor – $500

  • Your logo prominently displayed on the agenda and conference website and before all speaker sessions
  • Recognition as a conference sponsor at the opening of the conference in each time zone.
  • Exhibitor benefits, as below

Exhibitor - $200

Exhibitor Benefits:

  • Your video materials or PowerPoint with voice/sound at 2-3 breaks in each time zone.
  • Your name and exhibitor contact information on the conference agenda
  • Exhibit materials posted on the conference document site
  • Optional on-site display with one free admission to the origination site or to a group webcast site (CEs only if the exhibitor registers at conference rates)
Exhibit Schedule

Friday, October6, 2017

See exhibit times at conference breaks in your time zone. Note that participants in earlier or later time zones may be contacting you during additional exhibit times.

CONFERENCE SPONSORS: Send your logo immediately, for posting on the conference website, to Conference Coordinator Kay Slama, Ph.D. at . For more information, phone her at 320-905-6051.

EXHIBITORS AND SPONSORS: Send your video file or PowerPoint with voice/sound to Kay Slama, Ph.D., at . Be sure to include your cell phone number and email address prominently at the beginning and end of your exhibit.

Exhibitor/Sponsor Information

Choose an Option:

Conference Sponsor - $500

 Exhibitor - $200

Name of Organization: ______

Representative:

Title: ______

First Name: ______Last Name: ______

Address: ______

Address 2: ______

City ______State ______Zip Code ______

Email Address: ______Phone: ______

Exhibit Options: Please check one:

Our organization will be sending a PowerPoint file with voice/sound (up to 2 minutes) for the conference to

webcast at breaks

 Our organization will send a video (up to 2 minutes) for the conference to webcast at breaks

Our organization wishes to display both an exhibit in person at the conference origination or group webcast
site and aPowerPoint file with voice/sound (up to 2 minutes) for all participants to view.

(Visit for sites.)

Where do you wish to display your in-person exhibit? ______

Our organization wishes to display both an exhibit in person at a conference origination or group webcast
site and a video (up to 2 minutes) for all participants to view. (Visit for sites.)

Where do you wish to display your in-person exhibit? ______

Our organization will not be displaying an exhibit at the conference

Please check below if you are displaying in person and require these additional items:

Electricity Internet

Payment Information

Check (Made payable to MPA) VisaMasterCardAmerican Express

All credit card fields are required for credit card transactions

Card Number ______Exp. Date ______Security Code ______

Cardholder Name (print) ______

Cardholder Signature ______

Credit card billing address: Same as above

Address ______

City/State/Zip ______

Please do not email credit card information. Fax or mail your registration form to protect this information.

Return to: Minnesota Psychological Association, 4248 Park Glen Road., Minneapolis, MN 55416 or fax to 952-929-1318.

MPA Event Refund Policy: A 100% refund will be made if the event is cancelled.