EXHIBITOR REGISTRATION

2017 Annual Conference

April 21-April 23
The Stonewall Resort
940 Resort Drive
Roanoke, WV 26447
Please check one of the following:

$500 Standard Booth

Booth
Company name on Annual Conference materials

$675 Prime Booth

Preferred Booth location

Company name on Annual Conference materials
Company advertisement in WVPTA newsletters
Meal Sponsor- your name and/or logo displayed on signage
BONUS: Your Choice of ONE of the following...
Your company name/logo included in a Post-Conference Email Blast to all Attendees
A 3-month ad on the WVPTA website
One complimentary round of golf

$2,500 2017 Partner

First Choice of Preferred booth location

Company name on all WVPTA 2017 event material
(Annual Conference, PT After Hours, Payer Forum, Fall Conference)
Company advertisement and link to webpage on WVPTA website & newsletters
Database marketing (access to over 600 WVPTA member mailing labels)
Two complimentary rounds of golf

Name of Company _____________________________________________________________________________

Primary Contact (Mr./Mrs./Ms.)________________________________________________________________
Address ____________________________________________________________________________________
City

_____________________________________

Phone

(________) _________-_________________

Email

_____________________________________________________________________________________

Signature

State
FAX

_________

Zip_________________

(________) _________-_________________

___________________________________________________

Date_____________________

Name of person(s) with the exhibit (we understand this may change between now and the meeting)
Name

_________________________________________

Email

____________________________________________________________________________________
FAX

Title _______________________________

Phone

(________) _________-_________________

(________) _________-_________________

Name

_____________________________________

Email

____________________________________________________________________________________

Phone

(________) _________-_________________

Title _______________________________

FAX

(________) _________-_________________

Please include this form and a check by March 31, 2017 to :

WVPTA, 650 Main St. Barboursville, WV 25504
304-733-6484 phone | 304-733-6486 fax | info@wvpta.org