Conference 2009 - Exhibitor Participation Form

Celiac Sprue Association
Toll Free: 877-CSA-4-CSA
www.csaceliacs.info

PARTICIPATION FORM for Exhibitors/Donations
32nd Annual CSA Conference
Dietitian Day—October 29; Conference—October 30-November 1
Bayfront Convention Center—Erie, Pennsylvania

Exhibit Hall Dates October 29-31, 2009

Name of Company:___________________________________________________________________________________________

Authorized Company Representative:______________________________________________________________________________

E-mail Address:______________________________________________________________________________________________

Mailing Address:_____________________________________________________________________________________________

City, State, Zip Code:__________________________________________________________________________________________

Office Phone:_________________________________________Cell Phone:_______________________________________________

Fax:______________________________________Website Address:____________________________________________________

Additional Company contacts and email addresses:____________________________________________________________________

_________________________________________________________________________________________________________

I prefer to receive further information by ______email _____US mail ____both email and US mail

Annual CSA Conference Exhibit Hall Open Thursday 2:30 p.m. – Saturday 3:30 p.m.
___ I wish to participate as an exhibitor. ____ I am unable to attend, but wish to support the conference.
(Please complete #1,and/or #2 and #3 below) (Please complete only #2 and/or #3 below.)

1. I wish to participate as an EXHIBITOR in the Annual CSA Conference Exhibit Hall.

For the $450 registration fee I receive one 8’ by 8’ exhibit space with a 6’ skirted table, two chairs and a trashcan. Exhibit
Space does not include pipe and drape. Exhibit fee includes one lunch ticket for Friday and Saturday lunch with the Conferees.

NOTE: Fees increase to $600 after August 15, 2009

Total exhibit fee $_____________

For onsite hosting of your exhibit space by local CSA members, add $100 tax deductible donation (CSA will contact you)

Local Host Donation $___________

The following individual(s) will be assisting in this exhibit space: (Provide name(s) and title(s): ____________________________________

_________________________________________________________________________________________________________

______ I request additional exhibit space(s) if available. (CSA will contact you)

______ I will need electricity and a power strip in my exhibit space (no additional charge). I will be bringing/shipping the following equipment requiring

electricity:_________________________________________________________________________________________________

_________________________________________________________________________________________________________

______ I will be cooking or baking in my exhibit space

______ NEW THIS YEAR! I wish to participate in a cooking demonstration on Thursday. (See Q and A) CSA will contact you.

______ Our products require on-site refrigeration. (CSA will contact you)

______ I will be selling non-food items and will obtain the necessary Pennsylvania forms (See Exhibitor Q and A for instructions)

______ I will be shipping product to CSA Conference and will need to receive shipping information.

______ I need wireless Internet access in my exhibit space (no additional charge).

______ I need the following meal tickets:

#______ Friday Breakfast @ $25.00
#______Saturday Breakfast @ $25.00
#______ Sunday Breakfast @ $25.00

#_______ extra Friday lunch @ $25.00
#_______extra Saturday lunch @ $25.00
#_______ Friday Dinner @ $35.00
#_______ Saturday Banquet @ $40.00

Total meals $________________

2. I will submit on or before August 15, 2009, a black & white QUARTER-PAGE AD for the
31st Annual CSA Conference Syllabus at a cost of $175.

Total Advertising $____________

3. I would like to contribute to the success of the conference by providing:

GLUTEN-FREE PRODUCT DONATIONS :(Please indicate products you wish to contribute and the ‘in-kind donation” value))
Donations towards Conference Menus, Oktoberfest Buffet, Children and Youth Programming, Dietitian Day Meals and Snacks

Product(s):__________________________________________# servings __________________”in kind” value________________

FINANCIAL SPONSORSHIP THROUGH EDUCATIONAL GRANTS (Please see attached Sponsorship Form for
detailed descriptions)

Pre-Conference Activities

_______ Oktoberfest Buffet/Food Fair $5,000

Children and Youth Activities

_______ KidZone/Teen Scene support $2,000
_______ KidZone/Teen Scene Scholarships $125 each
_______ Young Adult Program support $1,000
_______ Young Adult Registration Scholarships $250 each

Dietitian Day Activities

_______ Conference Speakers $1,500 each
_______ Dietitian Day Conference Recordings $2,000
_______ CME/CEU Applications $1,500
_______ Dietitian Day Registration Scholarships $165 each
_______ Dietitian Day Syllabus $1,000
_______ Dietitian Day Luncheon $2,500
_______ Dietitian Day Speakers $1,500 each

Conference Activities

_______ Conference Syllabus $5,000
_______ Registration Bags $2,500
_______ Audio-visual support $5,000
_______ Conference Recordings $20,000
_______ Adult Registration Scholarships $400 each

_______ General Conference Support

_______ General Support of CSA

_______ Contact me about other sponsorship opportunities

Total Sponsorship $_______________

Total Payment $________

Participation form with full payment (check or credit card) must be received on or before August 15, 2009.

Payment Method:
Check ______ Payable to Celiac Sprue Association
Credit Card ______ Select: Visa _____ MasterCard _____ Discover _____ American Express _____

Credit Card Number: _________________________________________________________ Security Code: __________

Expiration Date: ________________________ Signature: ________________________________________________________

Mail to: CSA P.O. Box 31700 Omaha, NE 68131 Fax # 402-643-4108

Exhibitors: Please include the following with your completed participation form:

Signed copy of the Conference Exhibitor Agreement signature page
Proof of liability insurance naming CSA and Bayfront Convention Center, Erie Pennsylvania
Listing of products with ingredient lists
Sample order form (if selling product)
Sample handouts

Product Donations: Please include the following with your completed participation form:

Ingredient lists for donated products