Issue link: http://psai.uberflip.com/i/857947
Company Name: __________________________________________________________________________ Company Ad Contact: ______________________________________________________________________ Address: _________________________________________________________________________________ City: _____________________________ State/Province: ____________ Zip/Postal Code: _____________ Company Email: ___________________________________ Company Phone:________________________ Total Amount Due: ___________________ *Please call the PSAI office if you need assistance determining your total My check is enclosed OR please charge total amount to: ___ VISA ___ MASTERCARD ___ AMEX Cardholder Signature: ___________________________________________________________________________________ Cardholder Name (Please Print): __________________________________________________________________________ Card Number: ________________________________________________ Exp. Date: ________________ CSC: __________ Disclaimer: PSAI reserves the right, without liability, to reject, omit or exclude any advertisement for any reason at any time, whether or not such advertise- ment was previously acknowledged, accepted, or published. Advertiser/agency shall not submit advertising to PSAI that is discriminatory because of sex, race, religion, color, national origin, sexual orientation, gender identity, age, physical handicap or other improper basis, or advertising that contains derogatory comments about the advertiser's competitors or about the competitor's organization, products, systems or services. Advertiser is responsible for securing the rights to publish images included in ads submitted. BOOTH SPACE TOTAL AD SPACE TOTAL SPONSORSHIP TOTAL $ ___________ $ ___________ $ ___________ 2018 PSAI Convention and Trade Show EXHIBITOR REQUEST FORM Place your totals below in the allotted spaces. Include Silent Auction, Innovation Forum, and Scavenger Hunt amounts in your Sponsorship Total if applicable. All three pages of this form should be faxed, scanned, or mailed to the PSAI office. Following this form on pages 25-29 you will find the PSAI Application and Contract for Exhibit Space and the PSAI Convention and Trade Show Exhibit Space Agreement. Please read these documents in full and sign them where indicated. Pages 25, 26, and 29 should also be faxed, scanned, or mailed to the PSAI office with this exhibitor request form. If you have any questions regarding this form, the agreement, or the contract please contact the PSAI office at 952-854-8300 or at info@psai.org. 24