GAPA 2017 Conference Exhibitor & Sponsorship Registration


Please complete and submit the registration form below. If you prefer to send a check, please conplete the form below, print it, and mail the completed form, along with your check to the GAPA office at the address below.

Date:

Note that items marked with an "*" are required fields.

COMPANY INFORMATION
*Company Name:

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*Address Line 1:

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Address Line 2:
*City:

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*State:
Please select a state.
*Zip Code:

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*Contact Name:

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Contact Title:
*Contact's Email Address:

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*Contact Phone Number:

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Contact Phone Extension:
Enter numeric extension
Cell Phone Number:
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Fax Number:
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Company Website:
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*Exact Name on Booth Sign:

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Companies Preferred in Close Proximity:
Companies to Avoid Placement by:
 
EXHIBITOR OPPORTUNITIES:
Register to sponsor at our CME Conference.

GAPA 2017 Conference:
$31,250 – Product Theater at CME Conference – Breakfast
$37,500 – Product Theater at CME Conference – Lunch
$1,750 – Exhibitor Booth Space Only
$3,000 – Registration Bag Sponsorship
$2,000 – Lanyards
$1,250 – 5K Fun Run/Walk
$1,250 – Blood Drive
$1,250 – Annual Golf Tournament
$1,000 – Set of Mailing Labels
$1,250 – Volleyball Tournament
Grand Total
$
 
PAYMENT INFORMATION
* Please complete all fields in this section.


Visa  MasterCard  Discover  American Express 

Please make a selection.

Credit Card #:
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First Name as it appears on Credit Card:
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Last Name as it appears on Credit Card:
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Expiration Date (MMYY format):
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Card Verification Code:
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      CVN    What is this?

Billing Zip Code:
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NOTE: As exhibit booths are assigned on a first come, first paid basis, we advise you to submit payment with your contract as soon as possible. Payment is required before booth setup. GAPA agrees to hold space for the company signing this application and returning it to the GAPA office with full payment (no refunds are permitted). The authorized signature makes this contract firm and binding and we understand and agree to abide by all rules, regulations and conditions of this contract. I am an authorized representative of the Company names above with the full power and authority to sign and deliver this contract.


  




Mail Instructions

Complete form and mail to: GAPA
1905 Woodstock Road, Suite 2150
Roswell, GA 30075
Payment is due with registration form.
Make checks payable to GAPA (GAPA'S Tax ID#: 58-1296375)
In accordance with the Americans With Disabilities Act, please call the GAPA office if you have any special needs.


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