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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First of all, thank you! Thank you for the magnificent website you have developed! I found some great information to help me with my fight against my own TBI. Resources just around the corner from where I lived that none of my doctors have referred me to are now at my fingertips. I continue to struggle and now am inspired to fight for others. I can't thank you enough for the work you have done.

Nicole Broussard

Individual with TBI

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Painting a mask and showing how it feels to live with a brain injury was a lot of fun and also made me feel good and important. People don't understand so thank you for allowing me to share how I feel. I can't wait to see my mask on the art display. Thanks for making me smile and feel good about myself.

Ada Henderson

Individual with TBI

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The stress of everything is overwhelming. Every place and person I have called has shut the door in my face, and I felt like I was drowning. No one wanted to help until I called you. You have been an angel sent to me who has been incredibly kind, willing to listen and also help find what we need. By sharing your own personal stories, you have shown me that there is hope. Having you to talk to has been such a comfort and I just can’t say thank you enough. This has been an incredibly hard road but now that I have found you, it has become easier because I know there is someone who cares. Thank you from the bottom of my heart, my sweet angel, and thank you for shining some hope back in my life.

Mary Katherine Greer

Caregiver

Resource CEnter

BIALA Annual ConferenceExhibitor Form