sponsors/vendors opportunities

SPONSOR AND EXHIBITOR APPLICATION

Please complete this application and fax it with credit card payment to:
Attn: Amanda Conway,
Texas Health Institute
8501 N. MoPac Expressway, Suite 300, Austin, Texas 78759
aconway@texashealthinstitute.org
512-279-3907

Organization: (As mentioned on all acknowledgements)

Contact Name:

Contact Title:

Phone:

Address: Street

City

State

Zip

E-mail Address:

Website:

*Additional Team Member Name : (after utilizing the complimentary registrations in your sponsor level) Team members in the booth will pay only $200.00

Contact Title:

Phone:

Address: Street

City

State

Zip

Email Address:

*Additional Team Member Name : (after utilizing the complimentary registrations in your sponsor level) Team members in the booth will pay only $200.00

Contact Title:

Phone:

Address: Street

City

State

Zip

Email Address:

*Additional Team members (after utilizing the complimentary registrations in your sponsor level) in the booth will only pay $200.)

Brief Description of organization (100 words):

Exhibitor / Sponsorship level selected:

Nonprofit - $500 Bronze -$3,000 Silver - $5,000 Gold - $7,500
Platinum - $10,000 Signature - $40,000

Additional Item & Event Sponsorship (upon availability)

Name appears on sponsor list on web site, in conference handbook and on signage. Sponsor of any of the additional items above receives complimentary Summit registration. Sponsors noted on signage for event. Sponsors of reception and meals will be publically recognized prior to the event.

Opening Reception - $ 10,000 Conference Tote Bags - $ 5,000
Lunch (2 avail.) - $5,000 Name Badge Lanyards - $ 1,500
Breakfast (2 avail) - $3,000 Intensive Workshops (4 avail.) - $3,000
Refreshment Break (3 avail.) - 2,000 Excercise Activity (2 avail.) - $1,500

Total of Selections:

Sponsorship/Exhibitor Package:
Non-profit Participating Organization Package:
Item & Event Sponsoship(s):
Meal Tickets (addtl booth mgrs - $200 per person): (Please include payment for meals for exhibit team members who do not have a full registration)
Total Payment

Payment Information: (make checks payable to Texas Health Instiute)

Check Enclosed Credit Card Send Invoice (30 days net)

Credit Card Information:

Amount to be charged:	Check one: Visa MC
Credit Card #:	Expiration Date:
I am an authorized representative of the company named above with full power and authority to sign this form and make this commitment.
(Please print name of individual )	(Please print title of individual)
(Authorized Signature )	(Date )

Please complete ALL appropriate sections of this application and return by mail or fax.

Payment: Under the terms of this agreement, the exhibitor/sponsor agrees to pay the total of fee with this application or within 30 days of receipt of an invoice, but in no case later than August 30, 2010. It is understood that failure by the exhibitor/sponsor to remit balance due by said date shall render this agreement invalid.

Cancellation Policy: Any exhibitor, sponsor, or other participant who cancels all or part of purchased exhibit space or sponsorship prior to August 1, 2010 shall receive a full refund, less a $100 administrative fee. Any exhibitor who cancels all or part of purchased exhibit space or sponsorship between August 2 and August 29, 2010 will receive a 50 percent refund. If cancellation in whole or part is made after August 30, 2010, the exhibitor / sponsor shall be liable to THI, as liquidated damages, for the unpaid balance of the total value of the exhibit or sponsorship cancelled. Cancellation requests must be submitted in writing to the below address.

Authorization: Exhibitor agrees to abide by the THI 2010 Exhibitor/Sponsor Rules and Regulations, is made a part of this agreement by reference and fully incorporated herein. If this application and agreement has not been received, properly signed, and accompanied by payment in full by August 30, 2010, it may be declared null and void so that exhibit space or sponsor benefits may be reassigned. Acceptance of this agreement by THI constitutes a contract.

We understand this application becomes a contract when signed by us and accepted by Texas Health Institute. We have read and agreed to abide by all rules and regulations, as outlined in the application form and the exhibitor/sponsor rules and regulations.

(Please print name of individual )

(Please print title of individual)

(Authorized Signature )

(Date )

Please complete this application and forward it with payment to:
aconway@texashealthinstitute.org
Texas Health Institute
Attn: Amanda Conway, 8501 N. MoPac Expressway, Suite 300, Austin, Texas 78759

Or FAX with credit card payment to Amanda Conway, THI at (512) 279.3911.

Questions? Contact THI at (512) 279-3915 or aconway@texashealthinstitute.org

Sponsors and Exhibitors are a vital part of the success of the Southern Obesity Summit. If you have any questions or have a unique idea that would make this Summit even more interesting, please call. We welcome your ideas and want to hear from you. We look forward to working with you and we want to make your time at the 4th Annual Southern Obesity Summit extraordinary!

- The Texas Health Institute team