2012 Exhibitor, Sponsor & Advertiser Application
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Organization *
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Name of Primary Representative *
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Contact Email *
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This will be the email address NCHN uses to correspond with you about the Conference.
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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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My organization is submitting this application to (check all that apply): *
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Exhibit
Sponsor
Advertise in
the Conference Program
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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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Exhibitor Level *
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For Profit Vendor:
$800
Not-for-Profit Vendor:
$500
NCHN Member
Business Partner: Free
NCHN Gold Business
Partner: Free
NCHN Silver
Business Partner: $250
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Booth Representative 1:
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Booth Representative 2:
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Booth Representative 3:
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I prefer a booth next to [name of organization]:
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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 Sunday Night Reception ($55/guest):
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Number of Guest Tickets for Monday Night Rockies Baseball Game ($85/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
Sunday Evening Opening Reception: $1,750
Luncheon/Awards
Event: $2,000
Monday Night Special Entertainment: $2,000
Tuesday Lunch:
$1,500
Wednesday
Closing Luncheon: $1,500
Tuesday Breakfast:
$750
President's
Breakfast: $1,500
Beverage Break: $500/break (5 available sponsorships)
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Advertisers
Advertising opportunities are available in the 18th Annual Educational Conference Program. Art work must be high-resolution (300 dpi jpg,pdf, ai, psd) and emailed to
csullenberger@nchn.org no later than March 15, 2012.
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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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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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NOTE: If you do not upload a logo, please email a high resolution (300dpi) copy to csullenberger@nchn.org by March 5, 2012 to have it displayed in the appropriate
locations
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Payment
Check must be received before NCHN can consider your application. Mail payment by March 1, 2012 to:
NCHN (National Cooperative of Health Networks Association)
c/o Rebecca J. Davis
624 South 1st Street
Montrose, CO 81401
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a. Exhibitor/Sponsor/Advertiser Amount= *
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b. Registration Fee for Additional Booth Representatives ($250 x Number of Representatives in Addition to the Primary Representative)=
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c. Sunday Night Reception Guest Tickets ($55 x Number of Guests)=
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d. Monday Evening Networking Event Tickets ($85 x Number of Guests)=
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Total Amount (a+b+c+d)= *
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Check Number
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Billing Address (if different from address above)
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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, 2012, to receive a refund (minus a $50 administrative fee).
Advertising cancellations must be received prior to March 5, 2012 to receive a refund (minus a $50 administrative fee).
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 *
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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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