57th Annual Professional Growth Conference - Texas Counseling ...
57th Annual Professional Growth Conference - Texas Counseling ...
57th Annual Professional Growth Conference - Texas Counseling ...
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TEXAS COUNSELING ASSOCIATION<br />
<strong>57th</strong> <strong>Annual</strong> <strong>Professional</strong> <strong>Growth</strong> <strong>Conference</strong> • November 20-23, 2013 • San Antonio, <strong>Texas</strong><br />
APPLICATION<br />
TEXAS COUNSELING ASSOCIATION APPLICATION AND AGREEMENT<br />
Applicant‘s Name:__________________________________________________________________________________________________________________<br />
Applicant’s Address: ______________________________________________________________________________________________________________<br />
City:_________________________________________________State:_____________________ZIP: ______________________________________________<br />
Applicant’s Website: _____________________________________________________________Applicant’s Phone:__________________________________<br />
Name of Contact Person: ________________________________________Phone of Contact Person:____________________________________________<br />
Email of Contact Person:____________________________________________________________________________________________________________<br />
Description of Product/Services: ____________________________________________________________________________________________________<br />
__________________________________________________________________________________________________________________________________<br />
__________________________________________________________________________________________________________________________________<br />
PLEASE PRINT CLEARLY. Information submitted above will be printed in the <strong>Conference</strong> Program Book, if received by July 31, 2013.<br />
Have you submitted a Call-for-Program to present at this conference? ❏ Yes ❏ No<br />
Have you exhibited with the <strong>Texas</strong> <strong>Counseling</strong> Association before? ❏ Yes ❏ No<br />
EXHIBIT SPACE<br />
____ <strong>Professional</strong> Exhibit Space(s)<br />
____ Commercial Exhibit Space (s)<br />
3/1 - 7/31, 2013 8/1 - 10/31, 2013 11/1 - 11/15, 2013<br />
_____$500/Booth _____$650/Booth _____$900/Booth<br />
_____$750/Booth _____$900/Booth _____$1,150/Booth<br />
Exhibit Space $_______<br />
Preferred Booth Location (see diagram on page 6): ____ 1st choice ____ 2nd choice ____ 3rd choice ____ 4th choice<br />
SPONSORSHIP see page 2 for more information<br />
For the levels marked below with an asterisk (*), please complete the following information:<br />
Sponsorship $________<br />
Name of Person(s) to Receive Complimentary Registration(s):____________________________________________________________________________<br />
Email(s): __________________________________________________________________________________________________________________________<br />
____ *Diamond Sponsorship ($15,000+)<br />
____ *Platinum Sponsorship ($5,000 - $14,999)<br />
____ *Gold Sponsorship ($3,000 - $4,999)<br />
____ *Silver Sponsorship ($2,000 - $2,999)<br />
____ Bronze Sponsorship ($500 - $1,999)<br />
ADVERTISING<br />
Select which book you wish to advertise in (You can advertise in both):<br />
❏ Pre-Registration Book ❏ Program Book<br />
Advertising $________<br />
Full Page: Exhibitor Price: $625 Non-Exhibitor Price: $700<br />
Half Page: Exhibitor Price: $400 Non-Exhibitor Price: $475<br />
Quarter Page: Exhibitor Price: $250 Non-Exhibitor Price: $325<br />
TOTAL APPLICATION FEE: $________<br />
PAYMENT<br />
Payment must be received in full with the completed Application. TCA accepts cashier’s checks, checks, American Express, Discover, MasterCard<br />
and Visa for payment of Application Fee. Purchase Orders are not accepted.<br />
Paying by:<br />
❏ Cashier’s Check or Check<br />
Check Number: ________________<br />
❏ American Express ❏ Discover ❏ MasterCard ❏ Visa<br />
Credit Card Number: ____________________________________________________________________________________ Exp. Date:__________________<br />
Name as Printed on Card:____________________________________________________________________________________________________________<br />
I affirmatively authorize TCA to make charges to the above credit card sufficient to cover the Application Fee.<br />
Cardholder Signature: ____________________________________________________________________________________ Date: _____________________<br />
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