Advancing the National Health Promotion and Health Education Agenda

Through Effective Policies and Practices

 

24th National Conference on Health Education and Health Promotion

May 23-26, 2006

Hyatt Regency Crystal City

Washington, D.C.

 

In accordance with the rules and regulations covering the exhibit to be held in connection with this
national conference, the Undersigned hereby makes application for exhibit space. 
This Agreement is subject to all of the terms and conditions on the Exhibitor Prospectus
and made a part thereof.  We agree to accept the exhibit assignment made by DHPE.

 

Organization
Contact Person		Contact Title
Contact Address
Contact City		Contact State		Contact Zip
		Choose a State -------------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia 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 West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico Virgin Islands
Contact Telephone	Contact FAX
Contact Email

Exhibit Price:

Academic Programs:  $300.00
Non-Profit Organizations, Government:  $500.00
Commercial/For-Profit Organization:  $1000.00

Exhibitor Description (up to 75 words).   This description will be printed in the exhibitor packet given to conference participants.
Products/Services to be Displayed:
Door Prizes Donation:
Amount you are paying by Credit Card or Check: 300.00 500.00 1000.00   Select Payment Method Credit Card Check   Credit card number: Exp Date: 01 02 03 04 05 06 07 08 09 10 11 12   2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023   Cardholder’s first name: Cardholder’s last name :   Click here to Once you click the "Submit Exhibit & Print Contract", you will receive an email confirmation receipt. Please follow the instructions below to make your payment by check.

Government agencies may submit a purchase order with application.

 

Checks should be made payable to DHPE (Federal ID# 64-0856843)
If you are paying by check, mail a copy of your application and your payment to:
DHPE
c/o National Conference
1101 15th Street N.W.
Suite 601
Washington, DC 20005

   ___   Enclosed is one-half of the rental space fee. 

We understand final payment must be received by April 24, 2006, otherwise,
DHPE reserves the right to cancel this agreement and re-assign the space.

   ___   Enclosed is the exhibit fee in full.

   ___   Enclosed is a purchase order for the exhibit fee; please send an invoice.

 

Authorized Signature:                                                                                    Date: