2019 Vendor Application

CtHIMA 2019 ANNUAL MEETING

AUGUST 16, 2019

SHERATON HOTEL
1001 CAPITAL BLVD
ROCKY HILL, CT 06067

VENDOR APPLICATION

I. VENDOR DETAILS

Provide name, credentials, employer and title exactly as you want it to appear in the marketing and program materials.

Name *
First Name
Last Name


Credentials
Employer *
Job Title/Posiion *


Primary Address *
Street
City
  State
  Zip


Email *

Phone

II. REPRESENTATIVES WHO REQUIRE NAME BADGES

Representatives
First Name
1. *
2.  
3.  
Last Name


Email Address



III. BOOTH INFORMATION AND COST

$400 Standard 6ft skirted table. This price includes one person for the booth. Additional representatives at the booth will be $50 per person which includes food and beverages.

IV. SPONSORSHIP

Vendors who sponsor a meal or snack this year will be recognized as a Gold, Silver or Bronze medal sponsor and will receive free advertising on our CtHIMA website as follows:

Gold Medal sponsor – 6 months
Silver Medal Sponsor – 3 months
Bronze Medal Sponsor – 1 month

Please consider sponsoring one of the following venues.

Gold Medal Silver Medal Bronze Medal
Breakfast
Lunch
Afternoon Snack

V. PROGRAM ADVERTISING MATERIALS

Company advertising flyers can be inserted into the attendee program folders. If you would like to include a flyer from your company, please indicate below:

VI. AGREEMENT

Registrant Cancellation Policy
Anyone who pays registration fees and cannot attend the event may send a substitute. No fees will be refunded if you are unable to attend.

Insufficient Check Funds Policy
If a check is returned due to insufficient funds, you will be responsible for paying for all returned check service charges.

Exhibitor Agreement
The exhibitor booth and sponsorship are non-refundable. Substitutions or changes to attendees are to be emailed to .

The exhibitor agrees to release and hold harmless the Connecticut Health Information Management Association, its officers, representatives, agents and directors for all liability whatsoever for any loss, damage, or injury resulting directly or indirectly from any cause whatsoever in connections with the CTHIMA Annual Meeting and execution of this agreement.

Acceptance of Terms and Conditions:

I have reviewed and acknowledge acceptance of the Terms and Conditions (below) which include the cancellation policy, insufficient check funds policy, exhibitor agreement and insurance.

Signature *

Date