2023 Exhibitor Registration

Exhibitor Registration

2023 Turn on the Light Conference
Company Name*
Contact Person*

PrefixFirst NameLast Name
Title
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Please select your method of payment*

Check (mail in)Credit Card (PayPal)Credit Card (phone)
Registration Rates (please select all that apply)*

$325 Corporate Exhibitor - Includes one table and one representative (may attend workshops and luncheon)$250 Nonprofit Exhibitor - Includes one table and one representative (may attend workshops and luncheon)$165 Additional Representative - Second representative at the table (may attend workshops and luncheon)
Rate total
Registration Rates (select all that apply)*
prevnext( X )
Corporate ExhibitorIncludes one table and one representative (may attend workshops and luncheon)
$325.00



Nonprofit ExhibitorIncludes one table and one representative (may attend workshops and luncheon)
$250.00



Additional RepresentativeSecond representative at the table (may attend workshops and luncheon)
$165.00



Total

$0.00
Will the contact person be manning the exhibitor table?*

YesNo
Vegetarian meal requested?*

NoYes
Exhibitor Name*

PrefixFirst NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Vegetarian meal requested?*

NoYes
Additional Representative Name*

PrefixFirst NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Vegetarian meal requested?*

NoYes
TOTAL DUE: ${rateTotal} (Total may not calculate properly if using Firefox browser)

**payment must be received within 15 days of this registration and no later than 3/31/23 in order to guarantee your space**
Please call 561-687-8115 to submit your credit card information.
Please make check payable to: The Children's Healing Institute

Mail to: 2161 Palm Beach Lakes Blvd, Suite 212, West Palm Beach, FL 33409
Please use the space below for any comments or questions.
All registrations are final and non-refundable.
Should be Empty: