Celiac Support AssociationCeliac Support 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________________

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

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

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 Support 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