Sponsor/Exhibitor Registration Form
Exhibitor Information
Contact Name
*
First Name
Last Name
Business Name
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
Mobile Phone
Contact E-mail
*
example@example.com
Sponsorships
I want to be a sponsor! Sign us up for a Sponsorship+ Package!
No sponsorship / Exhibitor Booth Only
Platinum Sponsorship $5000
Gold Sponsorship $3500
Silver Sponsorship $2000
Bronze Sponsorship $1500
Sign us up for a Diamond Level+ Package!
No sponsorship / Exhibitor Booth Only
Convention Bag $3000
Convention Shirt $3000
Convention Lunch $3000
Sign us up for a Ruby Level+ Package!
No sponsorship / Exhibitor Booth Only
Convention Badge $2000
Convention Lanyard $1500
Print & Digital Program $1500
Sign us up for a Sapphire Level+ Package!
No sponsorship / Exhibitor Booth Only
Breakout Session $1200
Selfcare Room $1200
Faculty CE Session $1200
Sign us up for a Emerald Level Package! (Exhibitor Booth Not Included in Emerald Level)
No sponsorship / Exhibitor Booth Only
Breakfast $300
Break $300
Door Prize $50
Door Prize $75
Door Prize $100
Door Prize $125
Door Prize $150
Door Prize $175
Door Prize $200
Other Donation
Exhibitor Only Package
Exhibitor Booth
Please Select
Exhibitor $500
Small Business $400
Non-Profit $300
Additional Booth Requirements (each booth includes a 6ft table & 2 chairs, table clothes are not provided).
Additional number of booth attendees
Briefly describe the products/services you will be exhibiting
not necessary but could be helpful for exhibitor setup
Add any additional requirements, comments, or invoice request for check submission
Please mail checks to PO Box 588, Belleville, MI 48112
Signature
Submit
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