Exhibitor Online Registration

Wyoming Hospital Association
Vendor Registration Form
August 30, 2023
* The following fields are required.

Organization (type name as it should appear on Convention materials)

Address

City

State

Zip Code

Phone

Contact Person

E-Mail Address

Name & Title of those staffing your booth:
(Registration is for two (2) attendees)

Name

Title

Booths will be assigned on a first come, first served basis.

Please upload your company logo here, or email it to [email protected]

File types allowed: jpg, png, pdf. Max file size: 3.5MB

15-20 word description of the product or service of your organization, for the Exhibitor Listing:

We hereby agree to attend the 2023 WHA Annual Convention. We understand that if we cancel any time before August 1, 2023, that WHA will retain $50 of the exhibitor entry fee. Any cancellations after August 1, 2023 no refund will be issued by WHA. If paying by credit card and a refund is issued, please be advised that the credit card fees will be deducted from your refund.

Authorized Signature

Please type in First and Last Name

Date

mm-dd-yyyy

[Check all that apply]

Full Booth Exhibit Fee - $1000.00

Advertising Fee - $300.00

Sponsorship (Please also complete Sponsorship Form)

Additional Tickets for Attendees - $100.00 each

[ please list the first and last names of each Attendees in the box below ]

In order to better accommodate our vendors, this section must be completed if you have additional needs, i.e. electrical, Internet access, phone lines, or exhibits larger than the 6x8 allotted space. (Additional fees may apply). Please describe your requirements below:

Payment can be made by check or Pay Pal.

Exhibitor Online Registration

Booths will be assigned on a first come, first served basis.

Pay Now