BIALA Annual Conference
Exhibitor Form

The BIALA Annual Conference presents an incomparable opportunity to promote your organization to highly specialized professionals and strengthen your brand identity. Exhibitors will enjoy direct access to the leaders in our state and region who are helping to shape the future of brain and spinal cord injury treatment and rehabilitation.

BIALA Annual Conference Exhibitor Online Application

EXHIBITOR TYPE

Non-Profit ........................................ $200.00

Table in Vendor Exhibition area, with up to 2 people per table.
Access to the conference for 2 individuals with complimentary meals.
Listed as a vendor on BIALA website.

*There is a flat fee for those seeking CEUs: $50 per person.

Corporation ............................................. $350.00

Table in Vendor Exhibition area, with up to 2 people per table.
Access to the conference for 2 individuals with complimentary meals.
Listed as a vendor on BIALA website.

*There is a flat fee for those seeking CEUs: $50 per person.

General Contact Information

Company/Organization Name *

Name of FIRST Representative*

Email Address *

Phone Number *

Seeking CEUs? *

Yes

No

If Yes, list discipline:

Joining Us For Lunch? *

Yes

No

If Yes, list dietary restrictions:

Name of SECOND Representative*

Email Address *

Phone Number *

Seeking CEUs? *

Yes

No

If Yes, list discipline:

Joining Us For Lunch? *

Yes

No

If Yes, list dietary restrictions:

Business Mailing Address

City *

State *

Zipcode/Postcode *

Will You Require Electrical Setup? *

Yes

No

If Yes, please submit $20 electrical set up fee.

Is your organization willing to donate a small door prize (i.e. $25 gift certificate, goodies basket, etc.) *

Yes

No

Authorization for Photo,Video, or Audio Recording of Presentation:
I grant permission to BIALA, itsrepresentatives, employees and volunteers the right to take photographs, videoand/or audio recordings in connection with any educational presentation, andauthorize BIALA, its assigns and transferees the right to use or publish samein print or electronically.My name and date entered below is myapproval for BIALA to use photographs/video/audio recordings of me (with orwithout my name) for any lawful purpose, including education, publicity,illustration, advertising, and web content.

Please fill out our exhibitor form above, or click the button to download a paper copy.

DOWNLOAD OUR EXHIBITOR APPLICATION

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On a day that everything seemed to be going against me, I reached out for some help and was surprised that they actually were there to help me. My wheelchair was broken, and they were able to find a place to fix it for me. They educated me about the trust fund for people with spinal cord injuries and sent me an application. When I had questions about the application, I called back and was given the time and help needed to complete the application. They made me feel important so I am very thankful.

Robi Harsch

Individual with SCI

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Working as an advocate with spinal cord injury individuals, I have found very useful information from BIALA. They are quick to respond to my inquiries, and we work well together to find the resources individuals and caregivers need. Life with spinal cord injuries can be challenging so it is wonderful to know I have an organization such as BIALA to work with to make a difference in the lives of those we serve.

Nick Kylo

SCI Advocate

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My son sustained a spinal cord injury a few years ago, and I still rely on the resources BIALA has to offer to help us live our lives. When I am feeling down and need some encouragement, the BIALA hotline is the first place I reach out to. I feel a sense of relief after I call because of the kindness and compassion I am given. BIALA seems to really care about those they serve, and I am so thankful to have someone to talk to.

Berly Rose

Caregiver

Resource CEnter

BIALA Annual ConferenceExhibitor Form