CRWAD - Table Top Exhibit Application Form
The 2015 CRWAD Meeting, Symposiums, and Satellite Meetings will be held December 6 – 8, at the Chicago Marriott, Downtown Magnificent Mile, Chicago, Illinois. Table Top Exhibits will begin Sunday morning, 10:30 AM, with set–up at 10:00 AM, Dec 6. Exhibits will continue through Monday afternoon. Take down will be at 5 PM, Monday, Dec 7.
Application for table top exhibit space indicates the applicants willingness to abide by all accompanying table top exhibit terms and conditions, general regulations, as well as such additional rules and regulations as the CRWAD deems necessary to the success of the exhibition, provided these latter do not materially alter the exhibitors contractual rights. This application and table order will become a contract when counter–signed by the CRWAD Executive Director. Checks should be made payable to CRWAD. Please add 5% if pay by credit card.
Please note the Terms of Cancellation under Section C and the acceptability of exhibits under Section D of the Terms and Conditions as they will be strictly enforced.
Please down load, Complete and return by fax or email
1) TABLE TOP EXHIBIT
a) Complete this Exhibit Application & Table Order Form and send to Dr. David A. Benfield no later than October 22, 2015
b) Pay $1200.00 Exhibit fee to CRWAD.
c) Make check payable to CRWAD and mail to Dr. David A. Benfield
2) PAYMENT DESCRIPTION
Table Top Exhibit includes two people plus in-hotel delivery of materials to CRWAD Office Storage.
CRWAD Meeting Exhibitor Fee (Dec 6–7) $1200.00, amount paid $ __________
I need a power strip: yes ____; no ____; (if yes, additional $105)
Amount paid: $ __________ ; plus power strip $105, for a total $ __________
Please remit on or before October 22, 2015 or current date.
3) TABLE(S) REQUEST: (regular draped table is 6' x 30") Two chairs will be provided
Select only one of the following:
One regular table ______; Two regular tables ______
4) COMPANY INFORMATION
a. Company Name: ______________________________________________________________________________
b. Please email product description to CRWAD:
Please email a 50 word or less product description to firstname.lastname@example.org . Include the name of your company and web site.
c. Company Contact Person Name: ______________________________________
Contact Person Email: __________________________________________________________
d. You can supply names until October 22, 2015. Personnel names can be changed once you arrive at the hotel with a request to Dr. Benfield.
Onsite Company Personnel Name: 1. ____________________________________________________________
Onsite Company Personnel Name: 2. ____________________________________________________________
Company Name: _________________________________________________________________________________________
Mailing Address: _________________________________________________________________________________________
City: ________________________________________________________State: __________
Zip: ____________________Telephone: __________________________________ Fax: _________________________________
5) PAYMENT: Check OR Credit Card (circle one)
Make check payable to CRWAD and mail to the following address, or pay by credit card with the following information. Please add 5% fee to a credit card payment.
Credit Card Number __________________________________________________ Expiration Date _____________________
Verification No. __________(3 digit number which may follow a 4 digit number and appears on the signature strip on the back)
Name on the card _______________________________________________________________________________________
Street Address _______________________________________________ Zip/Country Code ___________________________
Type of credit card (Visa, MasterCard, American Express, or Discover) ____________________________________________
Total amount paid: $ _________________
Please include a Confidentiality Notice on the Cover Sheet when you fax your personal information. You may use the following statement:
"Confidentiality Notice – The content of this fax contains confidential information, intended only for the person(s) named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or any other use of this information is strictly prohibited. Please destroy the information immediately and all copies thereof. If you have received this fax in error, please notify us by telephone at 330–263–3703."
Mail or Fax this application by no later than October 22, 2015, to: (Fax No. 330–263–3688)
Dr. David A. Benfield
1680 Madison Avenue, Research Services Building Room 209e
The Ohio State University
Wooster, OH 44691
CRWAD Executive Director Signature: __________________________________________________________