Complete this form to reserve exhibit space for the Third Annual Palliative Wound Care Conference May 17-19, 2012, at Skamania Lodge in Stevenson, Washington. Please note that by submitting this form, you understand that your use of this space is subject to the conditions and terms attached, which upon acceptance by the Hope of Healing Foundation will become a binding contract between you, as the exhibitor, and the Hope of Healing Foundation.

EXHIBITING COMPANY INFORMATION:

Company name:

Address:

City:State:Zip code:

Telephone:Fax:

Contact name:Title:

Website:Email:

We agree to pay the total booth cost as rental for the space allotted to us. We understand that a 50% deposit must accompany the application. Final payments on all booths must be made by April 30, 2012. If you are requesting a booth after this date, payment in full must accompany application.

CANCELLATION: 

Cancellations before Mar 30, 2012 will result in forfeiture of 50% of the total booth fee; cancellations after this date will result in the forfeiture of the total booth fee. Notice of cancellations must be submitted in writing.

GRANTS/SPONSORSHIP:

 If you are are interested in sponsorship and grant opportunities for the Third Annual Palliative Wound Care Conference please call 513-891-3698.

Please enter your First name, middle initial, and Last name.  This will serve as an electronic signature.

Signature:Date:

Please check here if you do not wish to pay online. 

Exhibit Booth is 10’x10’.  Rate is $1,500 for the conference.

Click Submit to save your registration information and proceed to payment.