2013 Exhibitor, Sponsor & Advertiser Application
Exhibitors, sponsors, and advertisers should complete the form and mail payment by March 21, 2013.
High resolution (300di) logos, advertisements, and folder inserts must be received by March 21, 2013.
Please enter the information below as you would like for it to appear on the Conference website and in the Program.
For more information about any of these opportunities, visit the
Sponsorship Opportunities page
Name of Primary Representative
This will be the email address NCHN uses to correspond with you about the Conference.
My organization is submitting this application to (check all that apply):
Advertise in the Conference Program
Select your Exhibitor Category below.
In addition to the Exhibit fee, each booth representative must pay the reduced registration fee ($375/ea.) to cover costs of meals during the conference.
Non-NCHN Affiliated For-Profit Business: $800 (+ vendor's gift)
Non-NCHN Affiliated Non-Profit Business: $500 (+ vendor's gift)
NCHN Member Business Partner: Free (+ vendor's gift)
NCHN Gold Business Partner: Free (+ vendor's gift)
NCHN Silver Business Partner: $400 (+ vendor's gift)
Booth Representative 1:
Booth Representative 2:
Booth Representative 3:
I prefer a booth next to [name of organization]:
Optional: Please let us know if you prefer to have your booth located next to or near a specific organization.
Will you be attending the NCHN Opening Reception on Tuesday evening?
I/We will attend the Opening Reception
I/We will NOT attend the Opening Reception
Number of Guest Tickets for Tuesday Night Reception ($55/guest):
Enter the # of tickets for guests of Booth Representatives. Enter 0 if you will not be bringing guests to the reception.
Will you be attending the networking dinner and event on Wednesday night?
I/We will attend the networking dinner/event
I/We will NOT attend the networking dinner/event
Number of Guest Tickets for Wednesday Night Special Networking Event ($100/guest):
Enter the # of tickets for guests of Booth Representatives. Enter 0 if you will not be bringing guests.
Name of Guest(s)
If any booth representatives will be bringing a guest to the opening reception or Wednesday evening networking event, please enter the guest name/s.
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.
Platinum: $10,000 (EXCLUSIVE)
Conference USB Flash Drive: $3,500
Opening Reception: $1,750
Awards Luncheon: $2,000
Networking Break: $750
Advertising opportunities are available in the 19th Annual Educational Conference Program. Art work must be high-resolution (300 dpi jpg,pdf, ai, psd) and be emailed to email@example.com no later than February 15, 2013.
Conference Program Advertisement (Full Color):
Full Page: $800
Half (1/2) Page: $450
Quarter (1/4) Page: $250
Business Card (3.25" x 1.75"): $125
Information for the Website and Conference Program
All opportunities include logo and acknowledgement in the Conference program and Conference Web site
Description of your Organization/Service (as you would like to have it listed on the Conference Website and Program):
NCHN reserves the option to edit your description if it exceeds available space on the website or conference program (Recommended: 250 words or less).
Optional: Upload your organization's logo (1 MB max)
NOTE: If you do not upload a logo, please email a high resolution (300dpi) copy to firstname.lastname@example.org by March 21, 2013 to have it displayed in the appropriate locations
Check must be received before NCHN can consider your application. Mail payment by March 21, 2013 to:
NCHN (National Cooperative of Health Networks Association)
c/o Rebecca J. Davis
624 South 1st Street
Montrose, CO 81401
a. Exhibitor/Sponsor/Advertiser Amount=
E.g., $800 for Non-NCHN Partner For-Profit Exhibitor, $500 for Non-NCHN Partner Not-For-Profit, $400 for NCHN Silver Level Business Partner; $10,000 for Platinum Sponsor, etc.
b. Discounted Registration Fee for Booth Representatives ($375 x Number of Representatives)=
REQUIRED: Booth representatives must register for the conference to cover meal costs. The discounted conference registration fee of $375/ea. covers the Opening Reception on Tuesday night, 2 breakfasts, 2 lunches, the Wednesday night special networking event, and 2-3 breaks.
c. Tuesday: Opening Reception Guest Tickets ($55 x Number of Guests)=
d. Wednesday Awards Luncheon Guest Tickets ($47 x Number of Guests)=
e. Wednesday Evening Networking Event Tickets ($100 x Number of Guests)=
Total Amount (a+b+c+d+e)=
Billing Address (if different from address above)
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Trinidad and Tobago
Bosnia and Herzegovina
United Arab Emirates
Papua New Guinea
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Sao Tome and Principe
United Republic of Tanzania
Country / Region
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.
Terms & Cancellation
Note: Full payment must accompany an application for Exhibit space or Sponsorship. Payments must be sent by mail to NCHN, 624 South 1st Street,
Montrose, CO 81401. 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 March 1, 2013, 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.
After submitting your application, you will be redirected to the NCHN Conference Site. If you have any questions about this form or planning, contact Christy Sullenberger at 540-352-2529 or email@example.com
Terms & Cancellation
I have read and understand the terms and the cancellation policy above.
Please enter the text from the image: