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Send to 1.202.729.6728 Forum 2010 Exhibitor Registration Form

INFORMATION BOOTH OPTIONS
First Name _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _
Last Name _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _
As you wish to appear on your name tag at the forum
Title _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _
Organization _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _
_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_
q Member q Non-member non-profit q Corporate & Gov’t
Address _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ 1st_____________2nd_____________3rd_____________
_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_
City _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _
State _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | Zip _ | _ | _ | _ | _
Tel _______________
Fax _______________
Email _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _
Registration confirmation will be sent via email
ADVERTISING OPPORTUNITIES
Advertise in the Forum 2010 Program Advertise in Monday Developments
q 1/4 Page ($300) q 1/4 Page ($725)
q 1/2 Page ($450) q 1/3 Page ($860)
q Full Page ($600) q 1/2 Page ($1,040)
q Back cover (1/2 Page) ($1,130)
q Full Page ($1,725)
Check one: q InterAction Members
q Non-members/Non-profit Organizations
q Corporate & Government
Check one:
q Single Table Top q Double Table Top q Booth Pipe & Drape
q Please indicate your preference for booth location:
BE A SPONSOR AT THE INTERACTION FORUM
Corporate & Government Packages Non-profit Packages
q Diamond ($100,000) q Diamond ($80,000)
q Platinum ($75,000) q Platinum ($50,000)
q Gold ($50,000) q Gold ($30,000)
q Silver ($25,000) q Silver ($15,000)
q Bronze ($15,000) q Bronze ($5,000)
Additional Sponsorship Opportunities
q Our Forum program allows for additional sponsorship opportunities,
customized to enhance your organization’s visibility. Please select this
check box if you would like to receive more information on additional
sponsorship opportunities available to your organization.

MEALS & FUNCTIONS Need extra tickets?

MEALS AT THE FORUM ARE ORDERED BASED ON YOUR SELECTION BELOW. GALA PLENARY & AWARDS BANQUET
As part of our efforts to reduce the amount of food wasted, we ask that you ONLY select q Full Table (9 Additional seats for $800)
meals you will definitely attend. Functions that include meals are listed in bold letters. q Additional Seat
Tickets are $100 each. How many? _____
Wednesday, June 2 Thursday, June 3 Friday, June 4
TOTAL $ ___________
q Opening Plenary q CAW Plenary Breakfast q Exhibit Hours Breakfast
q Networking Luncheon q Plenary Luncheon q Closing Plenary Luncheon
q Plenary Session q Gala Reception q Workshops Only (no meals)
q Exhibit/Happy Hour q Gala Dinner
q Workshops Only (no meals) q Workshops Only (no meals)
SPECIAL ACCOMMODATIONS q I prefer vegetarian meals q I need a sign-language interpreter q Other ____________________________

ADDITIONAL Full Name _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ Full Name _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _

FULL CONFERENCE Title _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ Title _ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_
REGISTRATION Organization _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ Organization _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _

BOOTH PERSONNEL PASSES PAYMENT INFORMATION q VISA q Master Card q American Express
First Name _ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ Card Holder’s Name _ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_
Last Name _ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ Credit Card Number _ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_
Title _ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ Expiration Date ____/____/______
Organization _ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ Card Holder’s Signature __________________
_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ Date ____/____/______
First Name _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _
Last Name _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ Make checks payable to InterAction
Title _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ Be sure to write “EXHIBITOR PROGRAM” in the memo field. Send payments to:
Organization _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ | _ InterAction, Attn: Forum Registrar
_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ |_ 1400 16th Street, NW, Suite 210
Washington, DC 20036 USA
There will be $20 charge for each additional booth personnel. Please include in your total payment.
Tel: 1.202.667.8227