Exhibitor Registration Form Company Name(required) Levels of Donation(required)Support Levels Plumeria - $1,300 Hibiscus - $3,500 Pikake - *Full Cost of Guest Speaker (2-day Conference) Maile - $5,000 Program Sponsorship is Welcomed - What Support Level is Your Company Providing? Name of Primary Contact(required) *Please Provide Your Company's Primary Point of Contact (First and Last Names. Primary Contact's Email address(required) Primary Contact's Mailing Address(required) *Enter Your PO Box or Street Address City(required) State(required) Zip Code(required) Primary Contact's Phone Number(required) Name of Primary Representative Attending(required) Number of Additional Representatives Attending (Needed For Food Count)(required) 0 Additional Reps 1 Additional Reps 2 Additional Reps 3 Additional Reps 4 Additional Reps Other than your primary representative, how many additional reps are you brining to the conference? Note: Food & Beverage Fees - The Exhibit Fee includes continental breakfast, refreshments and lunch for one representative for the two-day conference as well as sponsorship of the pre-conference "Leadership Gathering". *Additional Representatives will be charged $100 per person, per day. Please indicate how many additional exhibitors you are covering for food and beverage costs on Day-1: Zero One Two Three Four Please indicate how many additiional exhibitors you are covering for food and beverage costs on Day-2: Zero One Two Three Four Do you require electricity at your booth? Yes No If YES, how many standard power outlets do you require? One Two Three Four Do you have any other special needs for your booth? If so, please explain here: Important Payment Information NOTE: After submitting the informational form here, proceed to payments in order to complete registration. Are you human?(required) This field should be left blank Submit Form Please wait... Exhibitor Payments Continue to Payments Cancellation Policy NOTE: Cancellations must be in writing. There is a 35% handling fee for cancellations received by September 1st, 2018. No refunds will be made thereafter.