RESERVATION FOR
EXHIBITS
MSHA
Annual Conference
March 13-15, 2008
Radisson Plaza Hotel,
Kalamazoo, Michigan
Company
Name
Company Representative
Address Local Address (if necessary)
City
& State
Zip
City & State Zip
Phone: Day: _________________________________
Evening:__________________________
FAX:____________________
Email address:_________________________________________
Donation for
Raffle:___________________________________
Please indicate the number of tables requested.
Tables are 8 feet in length, skirted, linen table covering, 2 chairs,
and a wastebasket. Electrical
outlets are an additional $30. Your fee covers all three days.
1 Table, no elec: $300 1 Table, with elec: $330 2 Tables, no elec: $500
2 Tables, withlec: $530 3 Tables, no elec: $650 3 Tables, with elec: $680
4
Tables, no elec: $750
4 Tables, with elec: $780
1 Unattended table for display of products
or catalogs: $100
Presentation/Seminar during conference: $200 Session length:
3
hours 2 hours
1
hour
1. Which
days will you be there?
½ day Thursday Friday
Saturday
2. Do
you require an electrical outlet?
Yes No (See
above for price differentiation)
3. Any
other special
requests?_________________________________________________________________________________
(Will accommodate if possible)
4. Please
indicate your choice (if any) of luncheons:
/ /Friday
Awards Lunch $25 ___Regular ___Vegetarian
Total: $_______
/
/Saturday
PSC Forum Lunch $20
/
/ Saturday Med SLP Forum
Lunch $20 ___Regular
___Vegetarian Total: $_______
5. Are
you interested in any of our sponsoring choices at this conference? (See Sponsorship
Opportunities) /
/Yes
Please return
this form with either your check, made payable to MSHA,
or charge option (see below) by
February 15, 2008. Exhibitors
will be accepted on a first-come, first-served basis.
Thank you! Hope to see you
in Kalamazoo!
Nancy
Nelson, M.A., CCC-A
Julie
Fisk, M.A., CFY-SLP
Professional Hearing Consultants, East
Lansing
Ingham Regional Medical Center
MSHA
790 W.
Lake Lansing Rd., Suite 500-A
East Lansing, Michigan 48823 msha@att.net
Phone: 517/332-5691 FAX: 517/332-5870 www.michiganspeechhearing.org
Payment Options:
Amount:
$___________________ Check
enclosed or:
VISA Card
#_______________________________________________________________
MasterCard
#______________________________________________________________
Discover Card
#____________________________________________________________
Expiration Date:_____________________
Card Holder
Name:______________________________________________________
Authorized Signature:____________________________________________