- All applicants must complete the form and mail payment
by March 31, 2011.
- Please enter the information below as you would like for it to appear on the Conference website and in the Program.
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Organization *
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Name of Primary Representative *
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Booth Representative 2: |
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Booth Representative 3: |
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Email *
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Phone Number *
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Fax Number |
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Website |
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Mailing Address *
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Information for the Website and Conference Program
All opportunities include logo and acknowledgement in the Conference program and Conference Web site
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Description of your Organization/Service (as you would like to have it listed on the Conference Website and Program): *
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NCHN reserves the option to edit your description if it exceeds available space on the website or conference program (Recommended: 250 words or less).
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Optional: Upload your organization's logo (1 MB max) |
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Exhibitors
Select your Exhibitor Category below. Also include the number of tickets needed for the Monday Night Networking event.
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I prefer a booth next to [name of organization]: |
Optional: Please let us know if you prefer to have your booth located next to or near a specific organization.
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Number of Guest Tickets for Monday Night Networking/Entertainment Event ($65/guest): |
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Sponsors
Select your preferred sponsorship level below. Sponsors are accepted on a first come, first served basis. If a sponsor has already selected your sponsorship event, we
will contact you by phone to arrange an alternate event or a refund.
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Sponsorship Opportunities
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Conference
USB Flash Drive: $3,500
Conference Tote
Bag: $2,000
Sunday Evening Opening Reception: $1,750
Monday Awards
Luncheon: $2,000
Monday Night Networking Event/Dinner: $1,750
Tuesday
Networking Lunch: $1,500
Wednesday
Closing Luncheon: $1,500
Tuesday Breakfast:
$750
President's Breakfast (Wednesday): $1,500
Beverage Break:
$500/break
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Optional (for Beverage Break Sponsors):
Preferences for Breaks are accommodated on a first come, first served basis |
Monday Afternoon
Tuesday Morning
Tuesday
Afternoon
Wednesday
Afternoon
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Advertisers
Advertising opportunities are available in the Official 17th Annual Conference Program. Art work must be high-resolution (300 dpi jpg,pdf, ai, psd) and emailed to
csullenberger@nchn.org no later than March 31, 2011.
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Conference Program Advertisement (Full Color):
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Full Page: $800
Half (1/2) Page:
$450
Quarter (1/4) Page:
$250
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Payment
Check must be received before NCHN can consider your application. Mail
payment by March 31, 2011 to:
NCHN (National Cooperative of Health Networks Association)
a/o Rebecca J. Davis
400 S. Main Street
Hardinsburg, KY 40143
Enter the dollar amounts in whole numbers (without decimals).
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a. Exhibitor/Sponsor/Advertiser Amount= *
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$
(Enter Total from above)
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b. Exhibitors Only: Registration Fee for Additional Booth Representatives= |
$
($250 x Number of Representatives in Addition to the Primary Representative)
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c. Monday Evening Networking Event Tickets ($65 x Number of Guests)= |
$
($65 X Number of Guest Tickets, if applicable
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Total Amount (a+b+c)= *
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$
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Check Number
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Billing Address *
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Note: By providing your contact information, you authorize the National Cooperative of Health Networks to communicate with you regarding event information and to
process your registration.
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Terms & Cancellation
Note: Full payment must accompany an application for Exhibit space or Sponsorship. Booth assignment will not be made without receipt of payment. Cancellation of exhibit
space or sponsorship must be received by the National Cooperative of Health Networks prior to April 1, 2011, to receive a refund (minus a $50 administrative fee).
Advertising cancellations must be received prior to March 15, 2011
to receive a refund (minus a $50 administrative fee).
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Terms & Cancellation *
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I have read and understand the terms and the cancellation policy above.
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Comments
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Image Verification
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