75th Anniversary ~ 6th Annual Session Exhibitor Registration Form

75th Anniversary ~ 6th Annual Session Exhibitor Registration Form

September 13-14, 2024
Meeting Information

Thank you for your support of NCDHA's 6th Annual Session!
September 13-14, 2024

Embassy Suites by Hilton Raleigh-Durham/Research Triangle
201 Harrison Oaks Boulevard
Cary, NC 27513

EXHIBIT HOURS
Friday, Sept. 13 | 10:30AM-2:00PM & 4:00-7:00PM
Saturday, Sept. 14 | 10:30 AM - 2:00 PM

EXHIBITS SET-UP Friday, Sept. 13 | 8:00 AM - 10:00 AM
EXHIBITS TEAR-DOWN Saturday, Sept. 14 | Begins 2:00 PM and must be finalized by 6:00 PM.

Company Information
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Contact Person

First NameLast Name
Contact Cell Phone
Please enter a valid phone number.
Contact Email
example@example.com

Sponsorship Information
Would you like to be a sponsor of the 6th Annual Session?

YesNo
Total Sponsorships
Meeting Sponsorships Available: (please see all sponsorship details and benefits outlined in the terms and conditions section of this form)

Oral Health Ambassador - $4500 - only 1 opportunity availableOral Health Patron - $3,500 - only 2 opportunities availableOral Health Champion - $2,500 - only 4 opportunities availableOral Health Advocate - $1,500Oral Health Crusader - $850Tooth Trot - $50

Additional Exhibitor Information
Please list any door prizes to be given away on Friday
I would like to donate my Friday door prize(s) to (please check all that apply):

the NCDHA mini rafflesthe NCDHA silent auctionI prefer to give my door prizes away at my table
Please list any door prizes to be given away on Saturday
I would like to donate my Saturday door prize(s) to (please check all that apply):

the NCDHA mini rafflesthe NCDHA silent auctionI prefer to give my door prizes away at my table
Please upload a high resolution jpg or png file of your company's most recent logo to be used in marketing materials

Cancelof
Friday lunch tickets - $45 per ticket (lunch tickets not included with table...if you are a sponsor, please review the sponsorship page of the prospectus to see if any lunch tickets are included)
Number of tickets to purchase
Saturday lunch tickets - $45 per ticket (lunch tickets not included with table...if you are a sponsor, please review the sponsorship page of the prospectus to see if any lunch tickets are included)
Number of tickets to purchase
Lunch tickets total
Half the Pot tickets - a book of 6 tickets for $5. Hep us grow the pot early...tickets will also be available for sale on site!
Please enter the number of books you would like to purchase
Name for Tickets
Phone Number
Please enter a valid phone number.
Half the Pot tickets total
Mini Raffles tickets - a book of 6 tickets for $5. Tickets will be placed in your exhibitor packet for you to place in the drawings on site
Please enter the number of books you would like to purchase
Name for Tickets
Phone Number
Please enter a valid phone number.
Mini Raffles tickets total
Wifi - $20 per day per device
Number of devices Friday
Number of devices Saturday
Wifi Total
Standard Electric

I would like to order standard electric for my table - $100
Extras total

Terms and Conditions

Please review the entire pdf exhibitor prospectus before proceeding
I certify that:*

I have read and agree to all the terms and conditions outlined in the 6th Annual Session Exhibitor Prospectus

Payment Information
Exhibitor Registration Subtotal
I would like to:

pay my exhibitor registration fee onlinemail a check to the NCDHA office
Please be advised that the check MUST be received within 10 business days of receiving your exhibitor application in order to reserve your table.
Would you like to donate 3% of the total for credit card processing fees?

YesNo
Credit Card Fee Donation
Exhibitor Registration Total

Should be Empty:

75th Anniversary ~ 6th Annual Session Exhibitor Registration Form

Meeting Information

Company Information

Sponsorship Information

Exhibitor Tables

Additional Exhibitor Information

Terms and Conditions

Payment Information

Credit Card