2008 NJHIMA Annual MeetingBally's Atlantic City Atlantic City, NJJune 19-20, 2008
Exhibitor Registration Form
* Required information
* Company Name
Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip Code:
* Phone:
Fax:
* E-mail:
Website:
Attendance
* 0 1 2 3 4 5 6 7 8 9 10 How many representatives will be in attendance?
Name Badges
Please list the participants that will require name badges. If you do not know who will be attending, please note “same” and you will be contacted directly in mid-May for this information.
First Name
Last Name
Booth Registration
Early Registration (On or Before April 15th)
Single Booth ($740.00) Double Booth ($1175.00)
Late Registration (after April 15th)
Single Booth ($800.00) Double Booth ($1225.00)
Once payment is confirmed, NJHIMA will contact you regarding your booth assignment.
Meal Tickets
To assist with meal planning, please indicate the number of attendees for each of the following:
Thursday, June 19th
0 1 2 3 4 5 6 7 8 9 10 Luncheon (not included in booth fee) ($45)
0 1 2 3 4 5 6 7 8 9 10 *Buffet Reception ($80)
Friday, June 20th
0 1 2 3 4 5 6 7 8 9 10 Brunch (not included in booth fee) - ($60)
0 1 2 3 4 5 6 7 8 9 10 Box Lunch (included in booth fee)
*Included in your exhibitor registration is the buffet reception on Thursday. Your registration fee includes up to 3 tickets for a single booth and up to 6 tickets for a double booth.
Sponsorship
If you are interested sponsoring an event or item for the meeting, please check the applicable box below.
The items with an ** were sponsored last year and that exhibitor has the right of first refusal. NJHIMA will advise if that opportunity is available. If you have a question regarding sponsorship, please contact us.
AV equipment
**Candy
Display graphics/signage
**Folders
Handouts on CD
**Lanyards
**Scholarship Pins
Speaker(s)
Table Decorations
**Tote Bags
Other
Thursday
UNAVAILABLE - Breakfast
Coffee Break - AM
**Luncheon
Coffee Break - PM
**Soda Break
Reception
**Antipasto Station **Carving Station UNAVAILABLE - Cheese Station **Chocolate Fondue Hors D'oeuvres Pastries **Pasta Station **Vegetables
Friday
**Breakfast
**Coffee Break - AM
**Brunch
To Go Lunch
Scholarship Donation
Are you interested in making a donation to the NJHIMA scholarship fund? You will be recognized in the annual meeting program.
Yes No
Annual Meeting Program
Advertising:
Please review program ad specifications. Submission deadline is May 11th.
UNAVAILABLE - Back Cover ($425)
UNAVAILABLE - Inside Back ($315)
UNAVAILABLE - Inside Front ($315)
Full Page ($200)
Half Page ($160)
Business Card ($75)
Product/Service Description:
Enter a concise, two-to-five line description.
Product/Service Type:
Check all that apply -
Contact Information:
Please list any changes from the contact information provided above that you would like printed differently in the program (e.g. contact name, phone number or email address).
I have reviewed and acknowledge acceptance of the terms and conditions which includes the cancellation policy, insufficient check funds policy, exhibitor agreement, and the credit card terms and conditions.
Do you have a question or comment? Please enter below and we will contact you.
Payment options include: Credit card and check If you would like a copy of this completed form, please print a copy before you select "continue" and continue with the payment process.
Payment options include: Credit card and check
If you would like a copy of this completed form, please print a copy before you select "continue" and continue with the payment process.
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