2017 AHME Institute VENDOR SUPPORT PROSPECTUS. Loyalty. in Support Prices! May 10-12, 2017 Astor Crowne Plaza New Orleans, LA

Transcription

1 2017 AHME Institute VENDOR SUPPORT PROSPECTUS in Support Prices! Loyalty Discount Program! Support Options! 2017 VENDOR SUPPORT HIGHLIGHTS * Support packages to give you more for your dollar! * Support prices the same as 2016! * New conference app sponsorships * Visit-Every-Exhibitor Drawing * Exclusive support options * Loyalty Program To find out how our vendor support program can meet your needs, contact the AHME Office: Sandi Parsons Director, Association & Meeting Services sandi@ahme.org Images throughout are courtesy of Steve Parsons Photography. All rights reserved.

2 2017 AHME Institute We Invite You... Dear Prospective Vendor Supporters & Exhibitors: Marko Jachtorowycz, MD, FACOG, FACS AHME President On behalf of the Board of Directors and the Academic Leadership and Professional Development Division (ALPD) of AHME, we invite you to become a vendor supporter of the 2017 AHME Institute. We continue our niche programming this year, which means a broader audience and even more promotional, networking, and selling opportunities for you. Who is the Association for Hospital Medical Education? AHME is a national, non-profit professional organization involved in the continuum of medical education, including undergraduate, graduate, and continuing medical education. Our membership consists of more than 800 key decision makers who are responsible for the management and direction of medical education programs at healthcare facilities throughout the United States. Marilane B. Bond, EdD, MEd, MBA ALPD Chair What Makes AHME Unique for Our Vendors? AHME is unique for you because our conference attracts attendees who are looking for practical, how-to information, networking and resources. That attraction fits perfectly with their desire to meet and interact with vendors like you. They are influential, involved in the profession, and make decisions at all levels. The 2017 event is being held in New Orleans, Louisiana. Attendees will have ample time and easy access to you in the exhibit hall at the. And, for 2017, we ve maintained the 2016 vendor support prices while keeping the same valuable benefits AND the loyalty discount program for repeat exhibitors. We ve got some new options this year as well since we will be utilizing a conference app for the first time. Kimball Mohn, MD Executive Director Your support is vital to the success of this conference, and our goal is for you to leave the 2017 AHME Institute knowing that you have connected more deeply with existing customers, as well as made valuable connections with new prospects and influencers. Sandi Parsons, Director of Association and Meeting Services, will work with you to determine the vendor support level that gives you the best value and impact for your budget as well as figure out your 2017 loyalty discount based on your past involvement with AHME. You can reach her at or sandi@ahme.org. We look forward to your participation in May, 2017! Marko Jachtorowycz, MD, FACOG, FACS AHME President Marilane B. Bond, EdD, MEd, MBA ALPD Chair Kimball Mohn, MD Executive Director 2017 AHME Institute Page 1

3 Why Become a Vendor? If you re new to AHME, you ll find that our vendor support program goes above and beyond other organizations to offer you more value and promotional opportunity. But, if you ve supported or exhibited with us in the past, you re really going to be excited about your LOWER cost with the application of the loyalty discount. Just a few of the benefits for 2017 include: All-inclusive package pricing gives you the best value for your dollar and the prices are the same as last year! Benefits in vendor support offerings to maximize your exposure Technology-centric support options Items that get your company s name in front of every attendee Loyalty Program Discount on exhibit booth for returning vendors See Pages 3 & 4 for Vendor Support pricing. WANT TO ZERO IN ON A NICHE? AHME has four Council meetings and two events at the Institute for our niche populations. Determine which group matches your product or service and sign up for exclusive vendor support opportunities. Choose from the following: 1) Council on Continuing Medical Education (CCME) 2) Council of Institutional Leaders (COIL) 3) Council of Transitional Year Program Directors (CTYPD) 4) Council of Program Administrators & Coordinators (COPAC) 5) Welcome Lunch for First-Time Attendees 6) AHME Leadership Reception Meet Our AHME Members AHME membership consists of over 800 professionals from all levels of the medical education industry, including undergraduate (UME), graduate (GME), and continuing medical education (CME). They come from large healthcare consortiums, as well as smaller community hospitals. Here is some important demographic and target market information that will help you decide how to spend your vendor support dollars with AHME. Decision Making Power 45% of AHME Members are in Top Management positions with titles like: President/CEO Designated Institutional Official (DIO) Dean of Academic Affairs Director of Medical Education Administrative Director Vice President, Medical Education Senior Vice President, GME 29% of AHME Members are in Middle Management positions with titles like: Manager, Academic Affairs Manager, Graduate Medical Education Medical Education Manager Program Director, Transitional Year Program Manager 26% of AHME Members are Frontline: Administrative Assistants & Coordinators U.S. Region Membership Concentration Region I: Northeast 144 Region II: Mid-Atlantic 153 Region III: Southeast 199 Region IV: Northern Tier 127 Region V: Midwest & South Central 147 Region VI: West AHME Institute Page 2

4 Vendor Support Packages & Exhibit Fees 2017 AHME Institute The following packages are all-inclusive for the 2017 meeting. They offer you the most value for your budget and give you the most marketing power. Compare the packages side-by-side on the next page and choose the one that best fits your goals! Exclusive Wi-Fi Sponsorship $6,000 Exhibitor Booth at 2017 AHME Institute (2.5 days) 2 Paid registrations and Course Materials 1/2-page advertisement in AHME Newsletter (Spring Issue) 25% discount on additional newsletter advertising in 2017 Attendee address list for use one time before and one time after the Institute Web banner on for 3 months (April, May, June 2017) Exhibit hall signage; acknowledgement in the conference materials & scrolling session announcements Exclusive Support of Niche Group Event, which includes attendance by one vendor representative One-time use of membership list of mailing addresses in 2017 (post-conference) Exclusive support of Wi-Fi and acknowledgement signage in conference meeting space Gold Supporter $5,000 Exhibitor Booth at 2017 AHME Institute (2.5 days) 2 Paid registrations and Course Materials 1/4-page advertisement in AHME Newsletter (Spring Issue) 25% discount on additional newsletter advertising in 2017 Attendee address list for use one time before and one time after the Institute Web banner on for 2 months (May and June 2017) Exhibit hall signage; acknowledgement in the conference materials & scrolling session announcements Exclusive support of Niche Group Event, which includes attendance by one vendor representative Silver Supporter $4,000 Exhibitor Booth at 2017 AHME Institute (2.5 days) 2 Paid registrations and Course Materials Business-card-size advertisement in AHME Newsletter (Spring Issue) 25% discount on additional newsletter advertising in 2017 Attendee address list for use one time before and one time after the Institute Web banner on for 1 month (June 2017) Exhibit hall signage; acknowledgement in the conference materials & scrolling session announcements Exhibitor Booth $3,000 Exhibitor Booth at 2017 AHME Institute (2.5 days) 2 Paid registrations and Course Materials Six (6) foot table, 2 chairs, and wastebasket We recognize your repeat business through our Exhibitor Loyalty Discount Program. If you have exhibited with us before, see your personalized from Sandi with your new, lower booth price for 2017! 2017 AHME Institute Page 3

5 Vendor Support Packages & Exhibit Fees 2017 AHME Institute Compare the package offerings from the previous page side-by-side in this grid! Exclusive Wi-Fi Sponsorship $6,000 Gold Supporter $5,000 Silver Supporter $4,000 Exhibitor Booth $3,000 Exhibitor Booth (2.5 days) 2 paid registrations and course materials Advertisement in AHME Newsletter (Spring issue) 1/2 page 1/4 page Business- 25% Discount on additional 2017 newsletter Advertising Attendee address list for use one time before and one time after the Institute Web banner on 3 months 2 months 1 month Exhibit hall signage Acknowledgement in the conference materials and scrolling session announcements Exclusive support of a Niche Group Event One-time use of membership list in 2017 Exclusive support of Wi-Fi and acknowledgement signage in conference meeting space Key Information & Important Dates Exhibit Dates & Times Hotel Contact AHME Meeting Planner May 10, 12:00 p.m. 3:00 p.m. Sandra Gold Sandi Parsons Setup/Exhibitor Registration Crowne Meetings Director Director of Meeting Services May 10, 3:30 p.m. 4:00 p.m. 109 Brush Creek Road May 11, 6:45 a.m. 6:00 p.m. 739 Canal Bourbon Street Irwin, PA May 12, 6:45 a.m. 3:30 p.m Phone: (724) Direct: (504) Fax: (724) Fax: (504) sandi@ahme.org sgold@astorneworleans.com See pg. 7 for Exhibit Hall Schedule 2017 AHME Institute Page 4

6 Exclusive Support Opportunities 2017 AHME Institute The following two pages list the available A la Carte offerings both exclusive and multiple vendor support opportunities. Conference Tote Bag (Exclusive) $2,500 exclusive; $1,500 each for two supporters Underwrite the cost of this high-quality conference tote that every attendee receives Place your name and logo exclusively on one side of the bag OR two vendors can share the space Acknowledgement will appear in the conference materials and scrolling session announcements Includes insertion of one promotional piece in Conference Tote Bag (needs prior AHME approval) Technology Charging Station (Exclusive) $1,500 Demo of your product or service on a video screen Exclusive support of electrical outlet station for attendees technology devices Identification in event signage as well as acknowledgement in the conference materials and scrolling session announcements Includes insertion of one promotional piece in Conference Tote Bag (needs prior AHME approval) Name Badge Lanyard (Exclusive) $1,000 Place your name & logo exclusively on the name badge lanyard every attendee receives Acknowledgement will appear in the conference materials Includes insertion of one promotional piece in Conference Tote Bag (needs prior AHME approval) Niche Group Events (Exclusive) $1,000 Welcome Lunch or Leadership Reception Be the only vendor to support one of these key events Includes attendance by one vendor representative Identification in event signage and acknowledgement at the event and in the conference materials Package supporters get priority 2017 AHME Institute Page 5

7 More Exclusive Support Opportunities & Multiple Support Opportunities 2017 AHME Institute Breakfast & Break Sponsorships (Exclusive) $500 Choose one of our all-attendee breakfasts (2) or breaks (5) Be the only vendor to support one of these key events Includes having your business cards and an approved promotional piece directly on food buffet Identification in event signage and acknowledgement in the conference materials Council Meeting Sponsorship (Exclusive) $250 COIL, COPAC, CCME, CTYPD Be the only vendor to support one of these key events Identification in event signage and acknowledgement at the event and in the conference materials Multiple Supporter Opportunities AHME Business Meeting Luncheon $1,000 Only vendors underwriting this event receive an invitation Includes attendance by two vendor representatives Identification in event signage as well as acknowledgement in the conference materials Verbal acknowledgement of your company s sponsorship App Advertisement $500 and up Place your name & logo exclusively on a page of the conference app Acknowledgement will appear in the conference materials Includes insertion of one promotional piece in Conference Tote Bag (needs prior AHME approval) AHME Member Mail List Rental $500 Includes entire AHME membership Mailing piece needs prior AHME approval Tote Bag Insert $500 Includes insertion of one marketing piece in the conference tote bag all attendees receive Marketing piece needs prior AHME approval Unrestricted Educational Grants any amount Identification in event signage as well as acknowledgement in the conference materials One complimentary conference registration for grants of $2,000 or more 2017 AHME Institute Page 6

8 Exhibit Booth Details and More Information The Exhibit Hall will remain open to conference attendees during conference hours from Wednesday afternoon until Friday afternoon. We ask that you comply with the exhibit set up and tear down times. EXHIBIT HALL SCHEDULE Wednesday, May 10, 2017 Exhibit Set-up & Registration Break with Exhibitors Thursday, May 11, 2017 Continental Breakfast with Exhibitors Break with Exhibitors Break with Exhibitors Meet the Exhibitors Reception Friday, May 12, 2017 Continental Breakfast with Exhibitors Break with Exhibitors Break with Exhibitors Exhibit Tear Down 12:00-3:00 p.m. 3:30-4:00 p.m. 6:45-8:00 a.m. 10:00-10:30 a.m. 2:00-2:30 p.m. 4:30-6:00 p.m. 6:45-8:00 a.m. 10:00-10:30 a.m. 3:00-3:30 p.m. 3:30 p.m. EXHIBIT SPACE Exhibit space in the Exhibit Hall at the should allow for spacious flow. A 6 table, cloth, two chairs, and waste paper basket will be provided. Booths will be assigned on the basis of specific needs and on a first-come, first-served basis. Every effort will be made to accommodate skyline displays with advanced notice. Exhibit rental does not include: 1. Security guard services 2. Placement of display equipment 3. Decoration and related expenses 4. Labor (i.e., carpentry, electricians) 5. Storage of any exhibit-related material 6. Lighting/electrical power to the booths 7. Gas, water or phone line, or Internet access Exhibitors who wish to utilized services or goods such as those outlined above are required to contract directly with the Astor Crowne Plaza to make appropriate arrangements and set up a billing method AHME Institute HOUSING & TRAVEL HOUSING Exhibitors at the 2017 AHME Institute are encouraged to utilize the group discount at the Astor. Room rates start at $199 single/double occupancy plus applicable tax. Advance reservations must be made by April 7, 2017 by calling and referencing the code A-H-M-E to receive the group rate or you may book via the Internet at ww.ahme.org. TRAVEL TO NEW ORLEANS, LOUISIANA Louis Armstrong New Orleans International Airport - just 20 minutes to the SHIPPING INFORMATION FREIGHT CARRIER No freight carrier has been named as the official provider for the 2017 AHME Institute. Exhibitors may use whichever company best suits their needs and budget. If you or your selected carrier have specific questions about delivery and/or pick-up at the, please contact Katrice Oreaboe in the Shipping and Receiving Department at: koreaboe@astorneworleans.com Phone: HOTEL SHIPPING INSTRUCTIONS All boxes should be addressed as follows. Multiple boxes should be numbered and all shipments sent no earlier than three (3) days prior to setup because of the Astor s limited storage space. Please notify Sandra Gold, Crowne Meetings Director, at the Astor, and Sandi Parsons at AHME of shipments in advance so we know what to expect. It is important that you complete the form on page 11 of this prospectus as well and return it directly to the. Hold For: Company Name: Arrival Date: 739 Canal Street Package handling fees are as follows: Per Box (inbound or outbound) Exhibit case (inbound or outbound) Pallet (inbound or outbound) $8.00 each $50.00 each $ each 2017 AHME Institute Page 7

9 Exhibitor Rules & Regulations Cancellations If space must be canceled, a full refund, minus a 10% administrative fee, will be made if written cancellation notice is received prior to April 23, Exhibitor Personnel Only persons with official badges will be admitted to the exhibit area and conference sessions. No more than two (2) persons may be designated to represent a single exhibitor during any time period, unless arrangements are made in advance with AHME staff. Mode of Exhibiting AHME will not permit exhibitor companies to offer premiums, such as TV sets, radios, etc. at booths to attract physicians and other conference attendees to buy directly from the company. Products and services offered by the exhibitor may be given away or purchased by order. Any practice in contradiction to these limitations will result in immediate removal of the exhibit and related personnel from the exhibit area. Character of Exhibits 1) Selling Outside Exhibit Space. Booth personnel, including demonstrators, are required to confine their activities within the exhibitor's booth space. Canvassing or distributing advertising material beyond the exhibitor's own booth is not permitted. Persons from non-exhibiting firms are prohibited from canvassing or "selling" within the conference areas or exhibit hall. 2) Soliciting. No exhibitor may invite a visitor out of one exhibit space into his or her own exhibit space. 3) Attire. Representatives should be conservatively attired to maintain the professional and businesslike climate of the exposition. 4) Noise and Odors. If the operation of any equipment or apparatus produces noises or vibration of sufficient volume or odors found to be annoying to neighboring exhibitors and guests, it will be necessary to discontinue such operation. 5) Hazardous materials. X-ray equipment may be exhibited but not operated. Volatile or flammable oils, gases, unprotected film and other explosive or hazardous materials are not permitted on the premises. Insurance It is the responsibility of each exhibiting company to obtain and maintain insurance coverage against injury to persons, damage to or loss of property and against inability to meet its obligations as outlined in the AHME Vendor Support Prospectus. The Association for Hospital Medical Education and the will not be responsible for an exhibitor's loss or damage of any kind. It is the sole responsibility of the exhibitor to obtain appropriate insurance coverage. Hold Harmless Clause The exhibitor assumes the responsibility and liability for losses, damages and claims arising out of injury or damage to an exhibitor's display, equipment and other property brought upon the premises of the hotel and shall indemnify and hold harmless the hotel agents, servants and employees from any and all such losses, damages and claims. Conflicting Event During Conference Hours The exhibitor shall not extend invitations, call meetings, hold hospitality events or otherwise encourage absence of attendees from the Exhibit Hall and meeting rooms during the hours of the conference. Public Relations The names and contact information of exhibiting companies and grantors/supporters will be published in the conference materials. Rules and Regulations AHME reserves the right to make such amendments and additions to these rules and regulations, as shall be considered necessary for the proper conduct of the convention. All such rules are made in the best interest of all exhibitors. It is unlikely that any modifications of the space allotted will be necessary. AHME reserves the right to make adjustments and add or delete exhibit space, if necessary. Failure to Hold Exhibit In the event the show is canceled because of reasons beyond the control of AHME, space rental fees already made will be returned to exhibitors on a pro-rated basis, after related show expenses incurred by AHME through the date of cancellation have been met plus any administrative fee and overhead charges. Force Majeure In the event that the or any part of the exhibit area thereof, is unavailable whether for the entire event, or a portion of the event, as a result of fire, flood, tempest or any such cause or as a result of governmental intervention, malicious damage, acts of war, strike, lockout, labor dispute, riot or any other cause or agency over which AHME or its representatives have no control, or should AHME decide because of any such cause it is necessary to cancel, postpone or re-site the Exhibit or reduce the installation time, exhibit time, or move-out time, AHME or its representatives shall not be liable to indemnify or reimburse the Exhibitor in respect of any damage or loss, direct or indirect arising as a result thereof AHME Institute Page 8

10 EXHIBITOR REGISTRATION FORM 2017 AHME Institute Important Note: This form is used to register with AHME as an exhibitor ONLY you must use the forms in the prospectus packet to secure power, Internet, and phone services for your booth. By submission of this completed exhibitor registration form, the company agrees to the terms and conditions of exhibiting at the 2017 AHME Institute as outlined in the AHME vendor support prospectus. Company Information Company Contact/Decision Maker Company Address City, State, Zip Phone Fax: Website URL Representative Information Two complimentary registrations are included with the exhibit fee. Additional representatives must register by completing an additional exhibitor registration form and submitting it with payment of $725 (the lowest participant fee available) per each additional representative above two. Representative #1 Representative #2 Name Name Address Phone Fax Address Phone Fax Company Bio Please provide a brief description (approximately 60 words or less) of your company and its products/services to be included in the course syllabus. We may need to edit if longer. Payment Method (select your support option on the Vendor Support Form) Make checks payable to 2017 AHME Institute Check enclosed Credit card information below Credit Card Information AHME Accepts MasterCard, Visa, and American Express Card Holder Name: MasterCard Visa AMEX Card Number: Expiration: I hereby authorize AHME to charge the credit card in the amount of $ (total from Vendor Support Form) Authorized Signer Date: Fax or scan/ the completed form with credit card payment to (724) along with the signed Vendor Support Form or mail this form, signed Vendor Support Form, and your check to AHME Headquarters; ATTN: SP; 109 Brush Creek Road: Irwin, PA

11 VENDOR SUPPORT FORM 2017 AHME Institute Company Name: Below are the vendor support opportunities. Please indicate your selected option(s). Benefits for each are listed on pages 3-6 in the Vendor Support Prospectus. Vendor Support Packages and Exhibits* $6,000 Exclusive Wi-Fi Sponsorship Loyalty Price*: $5,000 Gold Supporter Loyalty Price*: $4,000 Silver Supporter Loyalty Price*: $3,000 Exhibitor Booth Loyalty Price*: * AHME recognizes repeat business through the Exhibitor Loyalty Discount Program. If you have exhibited with us before, you will receive an from Sandi Parsons with your new, personalized, lower booth price for Exclusive Support Opportunities $2,500 Conference Tote Bag (reduces to $1,500 if there is interest by two sponsors) $1,500 Technology Charging Station $1,000 Name Badge Lanyard $1,000 Niche Group Event (select from the following) Welcome Luncheon Leadership Reception $500 Breakfast & Break Sponsorship (select from the following) Breakfast (Thursday) Breakfast (Friday) PM Break (Wednesday) AM Break (Thursday) PM Break (Thursday) AM Break (Friday) PM Break (Friday) $250 Council Breakfast (select from the following) COIL COPAC CCME CTYPD Multiple Support Opportunities $1,000 AHME Business Meeting Luncheon $500 & up App Advertisement (actual price to be determined) $500 AHME Member Mail List OR Tote Bag Insert $ Unrestricted Educational Grant (in amount indicated) AGREED My completion of this form and submission of full payment indicates that I agree to abide by all stipulations outlined in the AHME Vendor Support Prospectus. Acceptance of this application constitutes a contract. Name of Company Representative $ Total Due Signature Date OFFICE USE: Date check received Amount Check number Assigned Booth # Fax completed form with credit card payment to (724) along with the signed Exhibitor Registration Form or mail this form, signed Exhibitor Registration Form, and your check to AHME Headquarters; ATTN: SP; 109 Brush Creek Road; Irwin, PA Questions? Call Sandi Parsons at

12 EXHIBITOR SHIPPING INSTRUCTIONS TO HOTEL **The hotel does not accept any C O D deliveries** SEND TO: Hold For: Company Name: Arrival Date: 739 Canal Street Handling charges will be applied to all boxes received or shipped by the Receiving Department. $8.00 per box $50.00 Gray and Black or any colored cases $ Pallets The business center offers: Federal Express, Airborne, UPS and United Postal Services. To verify boxes received or ask about charges, please contact Ms. Katrice Oreaboe in our Shipping and Receiving Department, via at koreaboe@astorneworleans.com. HOTEL GUEST FAX NUMBER: HOTEL TELEPHONE NUMBER: Due to our limited space and the number of boxes received at the hotel, we ask you not to ship your boxes to arrive no earlier than 2-3 days in advance of your arrival date. Credit Card Authorization Due to an increase in credit card fraud and for the protection of the cardholder, we must request that this form be completed in entirety, including attachment of all requested items. Failure to complete any of these will result in non-approval. Please be aware that completion of this form does not ensure approval of your request. THANK YOU FOR YOUR COOPERATION. You are requesting the Hotel to bill charges to your credit card for the individuals and functions listed below. Please be certain that all signature requests are legible. Illegible information will result in non-approval of this request. Once completed, please forward to appropriate department. NAME (S) OF INDIVIDUALS/FUNCTIONS YOU ARE AUTHORIZING US TO BILL TO YOUR CREDIT CARD AND ARRIVAL/DEPARTURE DATES FOR EACH. Function/Group/Individual Name: I authorize the Hotel to charge this credit card as indicated above and any outstanding balance not Address: covered by advance payment, in the event that charges are not completely settled upon conclusion. I understand that detailed receipt will be mailed to me at the address provided above: Home Phone: Business Phone: Signature: Date: Card Number: Card Type: Exp.Date: Phone Verified: [Type text] Rer Arrival/Departure of Function Dates: CHARGES YOU ARE AUTHORIZING: SHIPPING AND RECEIVING CHARGES: YOUR INFORMATION AS IT APPEARS ON YOUR ACCOUNT: Last Name: First: Middle: Approval Code: Address Verified: THIS AREA TO BE FILLED OUT BY THE ASTOR CROWNE PLAZA HOTEL Amount Approved Not To Exceed: $ Date of Arrival Approved: Financial Institution Verified:

13 EXHIBITOR ORDER FORM-2016 Video Equipment Qty DAILY RATE Days Total Advanced* On Site** Used DVD Player $ $ Show/Convention Name: 32" Color Monitor (Not for computer use) $ $ " Plasma Monitor (Includes monitor stand)*** $ $ Show/Convention Dates: 55" Plasma Monitor (Includes monitor stand)*** $1, $1, For 46" & 55" monitors, specify if displaying on table or if stand is needed below: *** PSAV does not supply wall mounts or labor for mounting monitors to your hard sets*** Company/Organization Name: Billing Address 1: LCD Package Including projector, cart, power, VGA cable and 5', 6' or 7' tripod screen $ $ " Rolling Cart with Black Skirt $35.00 $50.00 Billing Address 2: Internet City: Qty DAILY RATE Days Total Advanced On Site Used State: Zip: Per Device-Basic Service-Wireless (includes 1 device connection and 1/8 Mbps of bandwidth) $95.00 $ Per Device-Basic Service-Wired (includes 1 device connection and 1/2 Mbps of bandwidth) $ $ Ordered By: PC Compatible Systems Qty DAILY RATE Days Total Telephone #: Advanced On Site Used Laptop Computer with CD drive $ $ Fax #: Please Note Specific Software/Hardware Needs Below: Customer Information Power Qty ONE-TIME FEE Total The total charge per item is determined by multiplying Advanced On Site the quantity by the daily rate by the number of days to 10 amp Single Phase Power $ $ be used. One-day charge for power & telecom. 20 amp Single Phase Power $ $ Power strip $15.00 $20.00 Please include applicable Sales Tax on all items. 25' extension cord $15.00 $20.00 TAX EXEMPT STATUS - If you are exempt Labor may apply to under carpet or complex booth sets. Computer Accessories HP Laserjet 4 Black & White Printer (8ppm, PC) 20" Wide Screen LCD Monitor from payment of sales tax, we require you to forward an exemption certificate for the state in which the Qty DAILY RATE Days Total services are to be provided. Advanced On Site Used Please fill in all blue areas plus the item(s) you are requesting! $ $ LABOR: Ordering Instructions $ $ Operator labor, if requested, is subject to the prevailing hourly rate with a 4 hour minimum. Audio Equipment CD Player Sound System with (2) speakers UHF Wireless Microphone (specify lapel or hand held) 4 Channel Mixer Qty DAILY RATE Days Total CANCELLATIONS: Advanced On Site Used Cancellation of your order must be received 48 hours $65.00 $90.00 prior to delivery date to avoid a minimum one day charge. $ $ Advanced = Order received by PSAV 11 days or more prior to installation. $ $ On-site = Order received by PSAV 10 days or less prior to installation. $75.00 $ Rental Totals TOTAL SET UP/PICKUP/SERVICE CHARGE (24% of Total - $75.00 minimum) On-Site Contact: Booth #: Room: SUBTOTAL Installation Date: Time: SALES TAX (11% of line Subtotal line) Show Start Date: Time: TOTAL DUE End Date: Time: Method of Payment PAYMENT IS DUE WHEN ORDER IS PLACED PLEASE CHECK ONE Delivery Information Return For Processing Card Number: American Express Exp Date / Cardholder's Name (as appears on card): Visa MasterCard Cardholders Signature: Billing Address Zip Code PSAV Hotel 739 Canal Bourbon Street kdonate@psav.com