IPS 2026 RIMHC Exhibitor/Sponsor Registration Credit Card Payment

2026 Advertiser/Exhibitor/Sponsor Registration Form

for Credit Card Payment

October 2-4, 2026

Planning Contact First Name

Planning Contact Last Name

Planning Contact Email

example@example.com

Confirm Email Address

example@example.com

Company Name

Company Address

Street Address

Street Address Line 2

CityState

Zip Code

Daytime Phone

Please enter a valid phone number.Format: (000) 000-0000.

Product/Service to be Featured

Likely On-site Representative

First NameLast Name

Likely On-Site Representative Email

example@example.com

Details

For discounted rate, form and payment must be received no later than 4/30/26
Sponsor and exhibit table requests will not be considered after 7/31/26
See corporate prospectus for benefits listing
Space assigned according to financial investment as well as order in which payment and form are received by organizers.
Space is limited and will sell out.

Corporate Guidelines – selection will not be confirmed without signature below.
Host organizers agree to begin providing benefits upon receipt of form and payment. Further, organizers maintain sole right to make all decisions concerning content, style and focus of all materials produced for the 2026 Regional Integrated Mental Health Conference. In no instance will a refund be considered once a corporate investment has been made. Participating companies will respect and abide by the decisions and policies of organizers and hotel to ensure a safe environment for all. Representatives found in violation of conference protocols will be asked to leave without refund.

Agreed to on: Date

Signature

2026 RIMHC Corporate Purchase Options

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year