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Attendee Exhibitor Sponsor Speaker Golf Only
Military Rank (if applicable) First Name Individual Attending the Conference Only
Middle Initial Last Name
Name to Appear on Badge
Position/Title
Name of Firm/Organization (include district/division)
Type of Organization Select One Small Business Large Business State/Local Government Federal Agency
Select all that apply
8(a)
Woman-Owned
Service-Disabled Veteran-Owned
Minority-Owned
Hub Zone
Small Business
City or APO/FPO
State Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware 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 Washington D.C. West Virginia Wisconsin Wyoming Other Zip
This Address is Select One Business Address Home Address
Email Address
Contact Phone - Ext. Fax -
Cancellations: Please note that a $75.00 administrative processing fee will be incurred for all cancellations through April 3, 2006. There are NO REFUNDS for cancellations after April 3, 2006.
Includes the Icebreaker, all Program General/Technical Sessions, continental breakfasts and luncheons.
If you would like to register as an EXHIBITOR or SPONSOR, please skip to the corresponding section below.
Conference Registration Selection $235 - Registration
View Exhibit Layout Exhibit registration includes one 10 x 10 exhibit booth space, one 8-foot table, skirting, two chairs, and ONE (1) FULL CONFERENCE REGISTRATION.
Exhibit Hall setup is Monday, April 24, 2006 from 2:00 p.m. to 7:00 p.m. and tear down is Wednesday, April 26, 2006 from 2:00 p.m. to 6:00 p.m. Additional exhibit hall passes are $195 each.
Exhibit Selection $500 - One 10 x 10 Exhibit Booth $1000 - Two 10 x 10 Exhibit Booths
Select booth location
1st Choice: 2nd Choice: 3rd Choice:
Select organization type:
Government Agency Non-Government Agency
Capabilities and NAICS codes for conference program: Limit to 100 words
One attendee is included with exhibit registration purchase: If you are the individual manning the booth and have already filled out the top portion of this form, please do not place you name below: Exhibit Full Registration (ONLY if different from above):
Full Name
Press selection below if you would like additional purchase additional exhibition hall passes:
Additional Exhbition Passes $195 - One Additional Exhibit Pass $390 - Two Additional Exhibit Passes $585 - Three Additional Exhibit Passes
Please provide the full name(s) of the individuals requesting additional hall passes:
Full Name - Separate by comma(s)
View Sponsorship Level Detail Indicate your sponsorship level choice below:
Sponsorship Selection $5,000 - Platinum $3,500 - Gold $2,500 - Silver $1,500 - Bronze
Please submit your logo and advertisement to holly.pierce@shawgrp.com no later than March 22, 2006.
Indicate below attendees included with sponsorship purchase of (Platinum and Gold Only):
Sponsorship Full Registration #1 (if different from attendee above only):
Full Name Sponsorship Full Registration #2
18-Hole Handicap (if handicap unknown, please leave blank)
Golf Reception 1 Ticket $25 2 Tickets $50 3 Tickets $75 4 Tickets $100
Full Names of Golfers
Special Accommodations (Americans with disabilities): if you need accommodations that meet the requirements of the individuals with Disability Act, please indicate specific requirement:
If you require an interpreter for communication purposes, please specify mode of communication:
NO REFUNDS ON ANY EVENT OR REGISTRATION AFTER APRIL 3, 2006. A $75.00 PROCESSING FEE WILL BE INCURRED WHEN CANCELING PRIOR TO APRIL 3, 2006. YOU MAY SUBSTITUTE A NAME WITHOUT PENALTY. Check Payment Please make payable to IMP/International Meeting Planners, Inc., and mail to address shown below:
SB Expo 2006c/o IMP/International Meeting Planners, Inc. Attn: Anna M. FloresP.O. Box 10807Corpus Christi, Texas 78460-0807
If sending overnight package please use our physical address: SB Expo 2006c/o IMP/International Meeting Planners, Inc. Attn: Anna M. Flores 2830 Tumbleweed Corpus Christi, Texas, 78410 361.241.4535
Credit Card Payment Require Delayed Billing: Yes
Type of Credit Card: Please Select MasterCard Visa
Credit Card Number:
Expiration Date: Month Jan Feb Mar April May June July Aug Sept Oct Nov Dec Year 2005 2006 2007 2008 2009 2010 2011 2012
Name as it appears on the credit card
Phone
Billing address as it appears on credit card statement
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Zip
Point of Contact for Billing:
Send my receipt/invoice to fax number (only if different from initial information provided above)
-
Email my receipt to the following Email (only if different from initial information provided above)
Comments: Limit 100 words
You will receive a confirmation page upon pressing the submit button below. If you do not, please call us at 361.241.4535 or email us at implanners@sbcglobal.net
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