GAPA Conference Exhibitor & Sponsorship Registration


Please complete the registration form below, print it, and mail the completed form, along with your check to the GAPA office at the address below.
 Secure Certificate



Date:


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

COMPANY INFORMATION
*Company Name:

A value is required.  Invalid entry.
*Address Line 1:

A value is required.
Address Line 2:
*City:

A value is required.
*State:
Please select a state.
*Zip Code:

A value is required.  Invalid entry. - Invalid entry. The entered value is less than the minimum required.  The entered value is greater than the maximum allowed.
*Contact Name:

A value is required.  Invalid entry.
Contact Title:
*Contact's Email Address:

A value is required.  Invalid entry.
*Contact Phone Number:

A value is required.  Invalid format.  Invalid entry.
Contact Phone Extension:
Enter numeric extension
Cell Phone Number:
Invalid entry.
Fax Number:
Invalid entry.
Company Website:
Invalid entry.
*Exact Name on Booth Sign:

A value is required.  Invalid entry.
Companies Preferred in Close Proximity:
Companies to Avoid Placement by:
 
EXHIBITOR OPPORTUNITIES:
Register to sponsor at our Summer Conference and/or our Winter Conference.


GAPA Summer 2012 Conference:
GAPA Spring 2013 Conference:
Exhibitor Category
(Select One):
  $24,500 – Classic Sponsor
  $65,750 – Official Conference Sponsor
  $97,200 – PA Month Sponsor

Exhibitor Category
(Select One):
  $24,500 – Classic Sponsor
  $65,750 – Official Conference Sponsor
  $97,200 – PA Month Sponsor

Grant:   $
Whole numbers only
Grant:   $
Whole numbers only
$1,750 – Exhibit Booth space only
$3,000 – Registration Bag
$2,000 – Lanyards
$1,250 – Back of Attendee Badge
$1,250 – 5K Fun Run/Walk*
$1,250 – American Red Cross Blood Drive*
$1,500 – half page ad GAPA´s quarterly Newsletter
$4,500 – GAPA Website (banner ad/three months)
$2,500 – GAPA´s Emails (boom box ad 2x)
$1,000 – Set of Mailing Labels
Conference Event Guide:
$2,500 – Full page ad
$1,250 – half page ad
$1,000 – fourth page ad
$1,750 – Exhibit Booth space only
$3,000 – Registration Bag
$2,000 – Lanyards
$1,250 – Back of Attendee Badge
$1,500 – half page ad GAPA´s quarterly Newsletter
$4,500 – GAPA Website (banner ad/three months)
$2,500 – GAPA´s Emails (boom box ad 2x)
$1,000 – Set of Mailing Labels
Conference Event Guide:
$2,500 – Full page ad
$1,250 – half page ad
$1,000 – fourth page ad
Subtotal $
Subtotal $
 
Grand Total
$
 


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.


Stay Connected to GAPA! GAPA Goes Green

GAPA GREENIn an effort to lower our environmental impact and preserve our natural resources, GAPA has elected to Go Green! Please look for our Green logo to learn more about GAPA's Green Initiatives.

The mission of the Georgia Association of Physician Assistants (GAPA) is to promote high quality, cost-effective, accessible health care as part of a physician-directed PA/physician team, to provide for personal and professional development of PAs, and to represent the PA profession in Georgia.

 

 

© 2011 • Georgia Association of Physician Assistants
1905 Woodstock Road • Suite 2150 • Roswell, GA 30075
Voice: 770-640-1920 • Toll Free: 1-888-811-GAPA • Fax: 770-640-1095 • info@gapa.net

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