EXHIBITOR AGREEMENT

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EXHIBITOR AGREEMENT 1100 Connecticut Avenue, NW, 12th Floor, Washington, DC 20036-4110 ● Tel: 202-822-2106 ●Fax: 202-822-2142 ● Web site: www.nchelp.org Name of Organization (as you want it listed in the Conference Program) Address City, State, Zip Code Phone and Fax Numbers Contact Person for Conference Information (and their email address) Name and Title of Person Receiving Complimentary Registration Please be sure to complete and return a separate conference registration form for each person from your organization attending the conference, including those receiving complimentary registration. Terms and Conditions of Exhibitor Agreement      One complimentary registration for each exhibitor. Booths will be assigned in order of receipt of both the completed and signed Agreement as well as receipt of your full payment by NCHELP. We must receive your agreement and payment in full 60 days prior to the Conference in order to properly acknowledge your organization in the program and on the signs. Organizations participating in more than one NCHELP conference or convention per fiscal year will be given priority in assignment of booths over those organizations participating in only one. Cancellation Policy – Cancellation in writing must be received by NCHELP no later than 60 days prior to the Conference in order to receive a full refund. Cancellations received after the 60-day deadline will result in a cancellation fee of $600. *We appreciate your assistance in respecting the privacy of attendees and request that the conference registration lists provided are not to be used to create e-mail distribution lists or for unsolicited marketing. Thank you. Signature of Authorized Representative Date Please mail your completed and signed agreement, and your check (made payable to NCHELP) to: NCHELP 1100 Connecticut Avenue, NW 12th Floor Washington, DC 20036 202.822.2142 (fax) NCHELP Employer ID: 54-1204566 Payment Information: Amount Enclosed (please check one): _____ $2,000 Member (DMC or Spring only) _____ $3,500 Member (DMC & Spring Conference) _____ $3,500 Non-Member (DMC or Spring only) _____ $6,500 Non-Member (DMC & Spring Conference) Check Number: ______________ Card Type:  AmEx  Visa Mastercard Card Number: ___________________________ Expiration Date:__________ Payment Information: Check Number: ______________ Card Type:  AmEx  Visa Mastercard Card Number: ___________________________ Expiration Date:__________

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