2014 PROSPECTUS AzPA Annual Convention

Transcription

1 2014 PROSPECTUS AzPA Annual Convention Sponsorship, Exhibitor, and Advertising Opportunities

2 December 1, 2013 Dear AzPA Supporter, The is pleased to announce the 2014 Annual Convention, the largest pharmacy meeting in Arizona. We will gather in Litchfield Park, Arizona at the historic Wigwam Resort, June 26 to June 29, This is your personal invitation to become a sponsor and exhibitor for this important event. We expect 500 attendees at the 2014 Annual Convention, including pharmacists, pharmacy directors, residents, students, technicians and other pharmacy professionals. Our membership encompasses all disciplines of the pharmacy profession community and retail practices, managed care venues, health-system and hospital pharmacies as well as representatives from both colleges of pharmacy in Arizona. Many of the attendees at this event are decision makers within their organizations and you will want to make contact with them. We acknowledge the value of our exhibitors by presenting two meeting functions in the Exhibit Hall. Your exhibitor programs will be held Friday, June 27, 2014, for an appetizer and cocktail reception from 5:00 pm to 7:00 pm and Saturday, June 28, 2014 from 11:45 am to 2:00 pm for a buffet luncheon. These functions are included in the conference registration and there are no conflicting events scheduled during this time. All attendees are invited and encouraged to visit and enjoy the meal functions in the Game Night-themed Exhibit Hall. Drive traffic to your booth by participating in the Exhibit Hall Blackout Bingo. As an exhibitor you may include your company on the bingo card. When attendees visit your booth, you will validate their entry ticket for the prize drawing. In addition, upon your company s paid registration, the list of attendees including contact information will be provided prior to AND after the event. Your participation as an exhibitor is very important to AzPA. This Exhibitors and Sponsors Application includes exhibitor fees and registration information along with great advertising opportunities and sponsorship packages. Single booth costs start at $1, This fee includes an 8 x 8 booth and exhibitor registration for two representatives. The deadline for early registration is May 15, 2014, and spaces will fill quickly. You don t want to miss this opportunity. Please complete your application and return it to AzPA at, Tempe, Arizona, or via fax at Register online! Visit for more information. Please call or Janet Weigel, Marketing and Communications, at janet@azpharmacy.org with any questions you may have. We look forward to seeing you in Tucson! Sincerely, Kelly Ridgway, R.Ph. Chief Executive Officer AzPA TAX EIN: E. Southern Avenue Tempe, AZ (480) Fax (480)

3 Pharmacists as Providers: Changing the Game T changing E a me PHARMACISTS AS PROVIDERS: SPONSORSHIP & ADVERTISING OPPORTUNITIES As an AzPA Annual Convention sponsor, you gain access to attendees in a dynamic way. Your company s support is recognized for its investment in the pharmacy profession. Sponsorship distinguishes your company as an industry partner. Each level of sponsorship offers benefits that provide enhanced access and exposure to meeting attendees. For more information, contact Janet Weigel, Marketing and Communications Manager, janet@azpharmacy.org or Tax ID AzPA Annual Convention Thursday, June 26 to Sunday, June 29, 2014 The Wigwam Resort & Spa 300 East Wigwam Blvd. Litchfield Park, Arizona This four-day annual convention provides continuing education, social, and networking opportunities for pharmacy professionals of all experience levels. Educational sessions focus on pharmacy topics pertinent to a variety of patient populations. Sponsors and exhibitors will have the opportunity to mingle and socialize with the attendees during the Exhibit Hall functions, breaks, and receptions. Attendance expectation: 500 (not including exhibitors) The 2014 AzPA Annual Convention will offer more than 15.0 hours (1.5 CEUs) of continuing pharmacy education for pharmacists and pharmacy technicians. In addition to the more than 25 CPE activities, the Convention features a special Student Track with unique programing for student pharmacists. Tentative Agenda-at-a-Glance Thursday, June 26, 2014 Arizona State Board of Pharmacy Meeting APhA MTM Certificate Program* AzPA Anticoagulation Certificate Program* AzPA Immunization Training Program* Product Theatre Luncheon* AzPA Board of Directors Meeting VIP Reception* Friday, June 27, 2014 APF Board Meeting PNA Board Meeting Residency Programs Consortium Awards Luncheon* Continuing Education Activities Exhibit Hall Reception* Saturday, June 28, 2014 Product Theatre Breakfast* Continuing Education Activities Exhibit Hall Luncheon and Reverse Expo* Legislative Panel* Health-System Leadership Track* Independent Pharmacy Owners Track* Past Presidents Reception* Saturday Night Social - sponsored by the AzPA Student Pharmacist Academy* Sunday, June 29, 2014 AzPA Town Hall Breakfast* Continuing Education Activities Product Theatre Luncheon* *Denotes sponsorship opportunity.

4 AzPA Annual Convention Pharmacists as Providers: Changing the Game Thursday, June 26 to Sunday, June 29, 2014 Arizona s largest annual pharmacy convention! Attendance expectation: 500 (not including exhibitors or sponsors) GENERAL CONVENTION SPONSORSHIPS Platinum $20,000 plus Diamond $10,000 to $19,999 Platinum $ 7,500 to $ 9,999 Gold $ 5,000 to $ 7,499 Silver $ 2,500 to $ 4,999 Bronze $ 1,000 to $ 2,499 Friends of Pharmacy - starting at $ 500 Multiple sponsorships are available. SPECIALTY ITEM SPONSORSHIPS Flash Drives $ 3,500 This permanent keepsake from the AzPA Annual Convention is pre-loaded with all the continuing education presentations and printed with both the sponsor s logo and the annual convention theme. This opportunity is limited to one sponsor. Tote Bags $ 2,000 This permanent keepsake from the AzPA Annual Convention is printed with both the sponsor s logo and the annual convention theme. This opportunity is limited to one sponsor. Name Badges $ 1,250 To attend all convention meal functions, general sessions, and workshops, all registrants must present their official AzPA Annual Convention name badge. This practical accessory bears both the sponsor and AzPA logos. This opportunity is limited to one sponsor. AzPA Annual Convention Event Program Advertising - 4-color only Full page - inside/outside cover $1,000 Full page - inside pages - $750 1/2 page - inside pages - $400 1/4 page - inside pages - $225 To sponsor a meal function or promotional item or to advertise in the event program, please complete the Annual Convention Exhibitor and Sponsor Application. For more information, contact Janet Weigel, Marketing and Communications Manager, janet@azpharmacy.org or Tax ID MEAL FUNCTION SPONSORSHIPS AzPA Awards Luncheon $7,500 This annual event marks the transition of the Association leadership. The AzPA Annual Awards are presented during this luncheon, honoring members for their contributions to the profession and the association. Sponsorship includes invitation to and recognition at the event, in the AzPA Journal, and the AzPA Annual Convention on-site program. Banner signage during session Logo recognition on AzPA website with link to your site for entire month of June 2014 Single exhibit booth - a $1495 value! This opportunity is limited to two sponsors. Product Theatre Meal Function Breakfast $5,000/day Luncheon $7,500/day This is your opportunity to present information about your product or services or therapeutic areas to pharmacists attending the AzPA Annual Convention. The material presented in Product Theaters may concentrate on a specific product. Therefore, these sessions are considered promotional and shall not offer continuing pharmacy education credit. Provide meal for all conference attendees 25-minute non-accredited presentation during lunch Logo recognition on AzPA website with link to your site for entire month of June 2014 Single exhibit booth - a $1495 value! Four opportunities are available for Product Theatre presentations; Breakfast - Thursday, June 26, 2014 Luncheon - Thursday, June 26, 2014 Breakfast - Saturday, June 28, 2014 Luncheon - Sunday, June 29, 2014 Break Sponsor $1,000/day Choose mid-morning or mid-afternoon break (20 minutes each). Display tables to include your company logo as break sponsor. Provide beverages and snacks for all attendees Name recognition on AzPA website for entire month of June 2013 Three opportunities are available for Break Sponsorship. Afternoon Break - Friday, June 27, 2014 Mid-morning Break - Saturday, June 28, 2014 Afternoon Break - Saturday, June 28, 2014

5 AzPA Annual Convention Pharmacists as Providers: Changing the Game Thursday, June 26 to Sunday, June 29, 2014 Arizona s largest annual pharmacy convention! Attendance expectation: 500 (not including exhibitors or sponsors) VIP Reception Starting at $1,000 Become a sponsor of this exclusive, invitation-only event for AzPA VIPs, Board of Directors, Speakers, Sponsors, and Arizona Legislators. Sponsorship includes invitation to and recognition at the event, in the AzPA Journal, and the AzPA Annual Convention on-site program. Multiple sponsorships are available. Past Presidents Reception $1,000 Celebrating the past, present, and future pharmacy leadership in Arizona, this invitation-only event honors the AzPA legacy. Sponsorship includes invitation to and recognition at the event, in the AzPA Journal, and the AzPA Annual Convention on-site program. Multiple sponsorships are available. Saturday Night Social Event $1,000 A great networking affair for young and old alike! This is a great opportunity to promote your products and services to future pharmacy leaders. Sponsorship includes invitation to and recognition at the event, in the AzPA Journal, and the AzPA Annual Convention on-site program. Multiple sponsorships are available. To sponsor a convention program, please complete the Annual Convention Exhibitor and Sponsor Application. For more information, contact Janet Weigel, Marketing and Communications Manager, janet@azpharmacy.org or Tax ID CONVENTION PROGRAM SPONSORSHIPS PLEASE NOTE: These programs are accredited continuing education activities and sponsorship is limited to corporate entities; sponsorship by a specific pharmaceutical product is not permitted. AzPA Legislative Panel $5,000 Presented by the AzPA Legislative Affairs Committee, this function features prominent Arizona political leaders and offers an opportunity to discuss current legislation affecting our state. Sponsorship includes invitation to and recognition at the event, in the AzPA Journal, and the AzPA Annual Convention on-site program. This opportunity is limited to two sponsors. Banner signage during session Logo recognition on AzPA website with link to your site for entire month of June 2014 Single exhibit booth - a $1495 value! AzPA Town Hall Breakfast $5,000 Presented by the AzPA Board of Directors, this function is an open forum presenting association resolutions, proposed bylaws changes, PharmPAC update, and current issues influencing the profession. Sponsorship includes invitation to and recognition at the event, in the AzPA Journal, and the AzPA Annual Convention on-site program. This opportunity is limited to two sponsors. Banner signage during session Logo recognition on AzPA website with link to your site for entire month of June 2014 Single exhibit booth - a $1495 value! Independent Pharmacy Owners Track $5,000 A special agenda of continuing pharmacy education developed specifically for independent pharmacy owners, including business strategies, unique market opportunities, theftprevention, and law updates. This opportunity is limited to one sponsor. Banner signage during session Logo recognition on AzPA website with link to your site for entire month of June 2014 Single exhibit booth - a $1495 value!

6 EXHIBITOR INFORMATION EARLY BIRD BOOTH REGISTRATION FEES Deadline for early registration is May 15, SINGLE 8 X 8 DOUBLE 8 X 16 TRIPLE 8 X 24 QUAD 8 X 32 $ 1,495 $ 2,345 $ 2,845 $ 3,145 REGULAR BOOTH REGISTRATION FEES after May 15, 2014 SINGLE 8 X 8 DOUBLE 8 X 16 TRIPLE 8 X 24 QUAD 8 X 32 $ 1,795 $ 2,645 $ 3,145 $ 3,445 NEW THIS YEAR! REVERSE EXPO Meet with Directors of pharmacy and management from community chains and health-systems pharmacy on Saturday afternoon. DRIVE TRAFFIC TO YOUR BOOTH! Participate in the Exhibit Hall Blackout Bingo Drawing To promote traffic to your booth, convention attendees will be encouraged to participate in Exhibit Hall Blackout Bingo. As an exhibitor you may include your company on the Bingo Card. When attendees visit your booth, you will validate their Bingo Card for the Exhibit Hall Prize Drawing. To become an exhibitor and/or sponsor of the 2014 Annual Convention, please complete the Exhibitor and Sponsor Application. AzPA Annual Convention Thursday, June 26 to Sunday, June 29, 2014 Arizona s largest annual pharmacy convention! Attendance expectation: 500 (not including exhibitors or sponsors) including pharmacists, pharmacy directors, residents, students, technicians and other pharmacy professionals. Our membership encompasses all disciplines of the pharmacy profession community and retail practices, managed care venues, health-system and hospital pharmacies as well as representatives from both colleges of pharmacy in Arizona. Many of the attendees at this event are decision makers within their organizations and you will want to make contact with them. We acknowledge the value of our exhibitors by presenting two meeting functions in the Exhibit Hall. Your exhibitor programs will be held Friday, June 27, 2014, for an appetizer and cocktail reception from 5:00pm to 7:00 pm and Saturday, June 28, 2014, from 11:45am to 2:00pm for a buffet luncheon. These functions are included in the conference registration and there are no conflicting events scheduled during this time. All attendees are invited and encouraged to visit and enjoy the meal functions in the Exhibit Hall. Upon your paid booth registration, the list of attendees including contact information will be provided prior to AND after the event. Your participation as an exhibitor is very important to AzPA. This Exhibitors and Sponsors Application includes exhibitor fees and registration information along with great advertising opportunities and sponsorship packages. Single booth costs start at $1, This fee includes an 8 x 8 booth and exhibitor registration for two representatives. For more information, contact Janet Weigel, Marketing and Communications Manager, janet@azpharmacy.org or Tax ID T changing E a m e PHARMACISTS AS PROVIDERS: vices Food Service Area 46 26' ' Food Service Area 50 6'

7 Benefits of Sponsorship: All sponsors and contributors to the AzPA Annual Convention will be recognized based on their cumulative dollar contribution to determine total sponsorship levels (does not include the cost of exhibit booth, banquet tickets/tables, additional representative registrations, or associate membership dues.) BENEFITS Premier $20,000 PLUS Diamond $10,000 to $19,999 Platinum $7,500 to $9,999 Gold $5,000 to $7,499 Silver $2,500 to $4,999 Bronze $1,000 to $2,499 Friends of Pharmacy up to $999 Recognition at Opening Session X X X X X X X Signage at Registration Desk X X X X X X X Invitation to VIP Reception X X X X X X X Recognition in the Arizona Journal of X X X X X X X Pharmacy Company Name/Logo with link on AzPA X X X X X X website* Special Recognition during AzPA Awards X X X X X X Ceremony Ad in Annual Meeting Onsite X X X X X Program** Exhibit Booth Discounts*** X X X X X Table for 10 at AzPA Awards Luncheon X X X Sponsor-Branded Product Theater Showcase X *One-month website advertising on AzPA Home Page **Ad size dependent on sponsorship level. Premier = Full page, outside cover; Diamond = Full page, inside; Platinum = ½ page; Gold & Silver = ¼ page. All ads 4-color. ***Discount dependent on sponsorship level. Premier & Diamond = free double booth; Platinum & Gold = free single booth; Silver = half-price single booth ARIZONA PHARMACY ASSOCIATION ANNUAL CONVENTION PHARMACISTS AS PROVIDERS: CHANGING THE GAME T changing E a me PHARMACISTS AS PROVIDERS:

8 AzPA Annual Convention Thursday, June 26 to Sunday, June 29, 2014 Pharmacists as Providers: Changing the Game T changing E a me PHARMACISTS AS PROVIDERS: To sponsor an award, complete the Exhibitor and Sponsor Application. For more information, contact Janet Weigel, Marketing and Communications Manager, janet@azpharmacy.org or Tax ID Award Sponsorships Each year, the recognizes those members who demonstrate outstanding leadership and dedication to the pharmacy profession. As an AzPA Award Sponsor, this is your opportunity to support the Association and the pharmacy profession in a unique, high-profile manner. Award sponsorship is acknowledged on the award itself, in the annual convention event program, in the Arizona Journal of Pharmacy, and at the award presentation. The sponsoring company is invited to have its representatives attend the awards ceremony and make the official presentation to the recipient. AzPA Pharmacist of the Year Award $1,000 An Arizona pharmacist who has actively demonstrated outstanding leadership and service for AzPA or for the profession of pharmacy in Arizona during the previous year. Accomplishments include providing significant AzPA organizational leadership and reflect ongoing personal time and effort to mentor and/or serve the needs of AzPA members and Arizona pharmacy. The AzPA Pharmacist of the Year Award is presented at the AzPA Awards Luncheon on Friday, June 27, AzPA Technician of the Year Award $1,000 An Arizona pharmacy technician who has excelled in the field of pharmacy technology and has demonstrated a high level of service and professionalism in pharmacy during the previous year. The AzPA Technician of the Year Award is presented at the AzPA Awards Luncheon on Friday, June 27, Elias Schlossberg Award $1,000 The highest level of recognition for an Arizona pharmacist who has made significant contributions to health-system pharmacy in the form of sustained exemplary lifetime service that reflects positively on the profession of pharmacy. The Elias Schlossberg Award is presented at the AzPA Awards Luncheon on Friday, June 27, Arizona Pharmacy Hall of Fame $1,000 In honor of a pharmacist member of AzPA with at least 10 years of practice experience in Arizona who has demonstrated innovation or excellence in practice, education, or research. This person is an Arizona pharmacy pioneer who has been instrumental in advancing the profession of pharmacy by promoting the importance of innovation and integrity in the field. The Arizona Pharmacy Hall of Fame Awards are presented at the AzPA Awards Luncheon on Friday, June 27, AzPA Exemplary Care Award $1,000 An Arizona pharmacist who provides or enables exemplary patient care, regardless of practice setting, by consistently providing exemplary patient care services, serving as a role model for contemporary pharmacy practice, or developing or fostering the development of an innovative pharmacy practice resulting in improved patient care. The AzPA Exemplary Care Award is presented at the Annual Convention Keynote Session on Saturday, June 28, 2014.

9 Sponsorship Packages Available PRODUCT THEATRE LUNCHEON $45.00/person* Provide lunch for all symposium attendees 35-minute non-accredited presentation during lunch Logo recognition on AzPA website with link to your site for entire month of the event Display space at event AzPA Fall Pharmacy Conference Saturday, October 25, 2014 Location TBD PRODUCT THEATRE BREAKFAST $30.00/person* Provide lunch for all symposium attendees 20-minute non-accredited presentation during lunch Logo recognition on AzPA website with link to your site for entire month of the event Display space at event EVENT SPONSOR $1,250 Name recognition on AzPA website for entire month of the event One (1) sponsored-event pass Display space at event BREAK SPONSOR $1,000 Choose mid-morning or mid-afternoon break (20 minutes each) Provide beverages and snacks for all attendees Name recognition on AzPA website for entire month of the event Event Program Advertising - black & white only Full page - inside/outside cover $500 Full page - inside pages - $375 1/2 page - inside pages - $200 1/4 page - inside pages - $125 *Alternative flat-fee pricing for Product Theatre sponsorship is available. Please contact AzPA for more information. For more information, contact Janet Weigel, Marketing and Communications Manager, janet@azpharmacy.org or Tax ID This conference provides continuing education, social, and networking opportunities for pharmacy professionals of all experience levels. Educational sessions focus on health care topics pertinent to a variety of practice settings. In addition to general sessions, breakout session topics are customized for specific audiences including community pharmacy, geriatric care, and technicians. Sponsors will have the opportunity to mingle and socialize with the attendees during lunch and breaks. Attendance expectation: 100 plus This day-long clinical meeting will offer approximately 6.0 hours (0.60 CEUs) of continuing pharmacy education for pharmacists and pharmacy technicians. Topics and fullaccreditation information will be available approximately 30 days prior to the conference.

10 Sponsorship Packages Available PRODUCT THEATRE LUNCHEON $45.00/person* Provide lunch for all symposium attendees 35-minute non-accredited presentation during lunch Logo recognition on AzPA website with link to your site for entire month of the event Display space at event PRODUCT THEATRE BREAKFAST $30.00/person* Provide lunch for all symposium attendees 20-minute non-accredited presentation during lunch Logo recognition on AzPA website with link to your site for entire month of the event Display space at event *Alternative flat-fee pricing for Product Theatre sponsorship is available. For information, please contact contact Janet Weigel, Marketing and Communications Manager, or Tax ID AzPA Anticoagulation Certificate Program Certificate Training Programs at the AzPA Annual Convention As an accredited provider of continuing pharmacy education programs, the is the premier provider in the Southwest of certificate training programs to enhance the pharmacist s practice. These certificate training programs are marketed across the United States and Canada and are well-attended by out-of-state practitioners. Anticoagulation Certificate Program developed by the This certificate program is a comprehensive program designed to provide pharmacists and nurses with the basic knowledge and skills necessary to care for patients taking anticoagulation therapies. Program Date: Thursday, June 26, 2014 Immunization Training Program developed by the This certificate program is a practice-based educational activity that teaches pharmacists the skills necessary to become primary sources for vaccine education, and administration. This Arizona-specific program reviews the reviews legal and regulatory issues pharmacists must consider before starting an immunization program and focuses on practice implementation. Program Date: Thursday, June 26, 2014 Delivering Medication Therapy Management Services developed by the American Pharmacists Association This certificate program is an innovative and interactive certificate training program that explores the pharmacist s role in providing MTM services to patients. Pharmacists have a tremendous opportunity to receive reimbursement for monitoring and improving medication use in patients with complex medication regimens. Program Date: Thursday, June 26, 2014

11 2014 Event Sponsor Form Company Name Exactly as it should appear in on-site program and on signage Corporate Contact Name: Address: Daytime Phone: address: Local Contact Name: (if different from above) Address: City/State/Zip: Daytime Phone: address: EVENT SPONSORSHIP Please indicate the name, date, and sponsorship package of the event your company wishes to sponsor. Event Name Sponsorship Package Level Date of Event Funding Amount in Dollars Special Considerations: EVENT PASSES INFORMATION - Number of Event Passes is dependent upon sponsorship level and event. ATTENDEE NAMES FULL DAY SPONSORED FUNCTION ONLY This form must be signed and returned to the AzPA office before acknowledgement and sponsor benefits are given. Balance must be paid in full within 30 days of the event. THE UNDERSIGNED AGREES TO SPONSORSHIP FOR THE AMOUNT INDICATED: Name and Title (please print): Signature: Date: PAYMENT INFORMATION Total Due $ Charge Card: Visa: MasterCard: Amex Discover Check # Card Number: Exp. Date: Security Code Signature: Make checks payable to. Mail this form to AzPA Annual Meeting, 1845 E. Southern Ave., Tempe, AZ or fax to Phone:

12

13 Advertising Contract Client Contact Address City/State/Zip Phone Fax Billing Contact Address City/State/Zip Phone Fax Complete the information below for each publication in which you wish to reserve space. Issue Ad Size B&W Color Special Positioning/Notes Rate Net Spring Journal Summer Journal Fall Journal Winter Journal Event Program* Website Sponsor Website Rotating AzCPE Career Center Pharmacy Flash *specify event in Special Positioning Notes section AGREED: All Terms and Conditions listed on the AzPA Rate Card are part of this contract. A signed original of this contract must be on file with AzPA before any insertion orders are accepted. Contracts cancelled after signed submission may be subject to a financial penalty. Advertiser Agency Printed Name Title Signature Insertion Order # Date Please send all Advertising Materials and Insertion Orders to: Janet Weigel Marketing and Communications fax janet@azpharmacy.org

14 Looking for a way to be involved with AzPA all year long? Become an Associate Member! Dues are just $100 per year for non-pharmacist members. Keep up to date on issues, events, and meetings important to the pharmacy profession as well as enjoy legislative representation on important pharmacy issues in Arizona and nationally. Associate Members enjoy all the benefits of AzPA membership with the exception of voting rights. Access member-restricted areas of the AzPA website, including the membership directory. To become an Associate Member of AzPA complete the Membership Investment Statement at right and return it to AzPA. Or join online at Look for the Join/Renew tab. For more information, contact Janet Weigel, Marketing and Communications Manager, janet@azpharmacy.org or fax: Tax ID Associate Membership Application Full Name : Preferred Address: City/State/Zip: Preferred Phone: Preferred address: Company Name Birthdate (MMDD) Gender: Female Male Website: Preferred Address is: Home Business Alternate Contact Information: Address: City/State/Zip: Phone: address: ACADEMY AFFILIATION: Community Pharmacy Geriatric Care Health-System Pharmacy Managed Care Technician Student Pharmacist PAYMENT INFORMATION Payment Amount: $100 Associate Member Dues Payment Method: If paying by credit/debit card, all fields are required. Check Credit/Debit Card Card Number: Expiration Date: Security Code: Name of Card: Billing Address: City/State/Zip: Signature:

15 2014 Annual Convention Exhibitor and Sponsor Application Company Name Exactly as it should appear in on-site program and on booth signage Corporate Contact Name: Address: City/State/Zip: Daytime Phone: address: Local Contact Name: Address: City/State/Zip: Daytime Phone: address: COMPANY REPRESENTATIVES - Two (2) per booth with exhibit fee Additional representatives are $50 each per day. Attach a separate page for each additional representative. Name: Address: City/State/Zip: Daytime Phone: address: Will be in attendance Friday Saturday Both Friday and Saturday Name: Address: City/State/Zip: Daytime Phone: address: Will be in attendance Friday Saturday Both Friday and Saturday CONTINUING EDUCATION OPTIONS Exhibitor Representatives interested in Continuing Education Programs may attend CE sessions for additional fees. CE fees do not include Awards Luncheon ticket. Single Day $60 per day/rep Please check which days you wish to attend CE Programs Full Conference $150/rep All three days (Fri, Sat & Sun) Name Name BOOTH PREFERENCE End booths are considered premium locations. AzPA sponsors receive priority reservations. Please refer to exhibitor on back page for booth numbers and locations. Fri Sat Sun Fri Sat Sun 1st CHOICE 2nd CHOICE 3rd CHOICE If possible, please do not locate us near the following companies: EXHIBIT HALL EXHIBIT HALL BLACKOUT BINGO PARTICIPATION Please include our company on the Exhibit Hall Blackout Bingo Yes No I will provide a door prize for the Exhibit Hall Blackout Bingo Drawing Yes No AzPA Awards Luncheon - Friday, June 27, 2014 ATTENDEE NAMES SINGLE TICKET TABLE OF TEN

16 2014 Annual Convention Exhibitor and Sponsor Application page 2 I. BOOTH REGISTRATION FEES SINGLE 8 X 8 DOUBLE 8 X 16 TRIPLE 8 X 24 QUAD 8 X 32 EARLY BIRD UNTIL MAY 15, 2014 $ 1,495 $ 2,345 $ 2,845 $ 3,145 STANDARD AFTER MAY 15, 2014 $ 1,795 $ 2,645 $ 3,145 $ 3,445 II. SPONSORSHIP PACKAGES (See page for details.) General Sponsorship - specify sponsorship level Product Showcase - specify event preference Break Sponsor - specify date(s) preference VIP Reception Past Presidents Reception Political Leadership Breakfast New Practitioners Reception Award Sponsorship - specify name of award Specialty Item Sponsorship - specify item III. ADVERTISING OPTIONS (see page 1 for details) Quarter-Page 4-Color Half-Page 4-color Full-Page 4-Color (inside pages) Full-Page 4-Color (cover pages) Annual Convention Program $ 225 $ 400 $ 750 $1000 IV. CONTINUING EDUCATION FEE PER REGISTRANT SINGLE DAY - FRIDAY - Does not include Awards Luncheon $ 60 SINGLE DAY - SATURDAY $ 60 SINGLE DAY - SUNDAY $ 60 FULL CONFERENCE - Does not include Awards Luncheon $150 NUMBER OF REGISTRANTS Section I Total Section II Totals Section III Totals Section V Total V. ADDITIONAL OPTIONS (Please include names and details on page 2) PRICE QUANTITY Section V Totals AzPA Associate Membership $100 Friday, June 27, 2014 Additional Representatives $ 50 Friday, June 27, 2014 Awards Luncheon - Single Ticket $ 45 Friday, June 27, 2014 Awards Luncheon - Table of 10 $400 PAYMENT INFORMATION Total Sections I, II, III, IV,V $ Less Sponsorship Discount ( if applicable) - Total Due $ Charge Card: Visa: MasterCard: Amex Discover Check # Card Number: Exp. Date: Security Code Signature: Make checks payable to. Mail this form to AzPA Annual Convention, 1845 E. Southern Ave., Tempe, AZ or fax to Phone: