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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When I called the helpline, I was so happy to learn about the trust fund I could apply for. I had no clue about it but am glad I know now because living with a brain injury is expensive and hard. The lady I spoke with was so nice, took the time to answer all my questions, and made me laugh. She gave me some hope and that is pretty cool.

Harry Thomas

Individual with TBI

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The BIALA hotline has been a huge source of hope for me. As the mother of a daughter who has a brain injury, it has been extremely comforting to be able to talk to someone who is empathetic, kind and comforting. Somedays I just need someone to talk to so it is great knowing there is someone there willing to listen to me.

Avery Shelton

Caregiver

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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