2009 Annual Conference

The LaQuinta Inn and Conference Center

Boone, NC

April 22 - 24, 2008

EXHIBITOR REGISTRATION - NONPROFIT

Company/Organization ________________________________________________

MailingAddress ______________________________________________________

E-MailAddress: ______________________________________________________

PhoneNumber(___)___________________ Fax(___)_________

Name(s)ofRepresentative(s) ___________________________________________

Single tables are $25.00 each and facility cost for each additional table. Please reserve _________ table(s) for us.

Each table will have two (2) chairs. I do ___ do not ___ need electrical power.

A Free luncheon will be provided on Thursday April 23^rd, 2009. One luncheon ticket will be provided to you. If you need additional tickets, please let us know at the registration desk at the conference.

In addition to exhibiting, our company/organization would like to sponsor a speaker or social function with a contribution of $___________________.

WNCPHA welcomes contributions of cash or items to be given to participating members as door prizes, some of which are tied to visiting exhibitors. Please accept our company’s/organization’s donation of $____________ in cash or (list items) ________________________________________________________________________________________________________________________________________

My company/organization cannot attend but would like to contribute $_________ or _______________________________________________________.

Please send completed form with your payment by March 15, 2009 to:

Heather Morgan-Gulnac, Vice President WNCPHA 2009

Burke County Health Department

700 East Parker Road

Morganton, NC 28655

Tel 828 448 3210

e-mail: Heather.Morgan@ncmail.net