Exhibit Space Registration

Please use this form to reserve exhibit space at the 2019 Healthy Schools Summer Academy. Exhibit space is $300 per display space. The deadline to reserve a booth is May 9, space permiting, with payment due April 30, 2019. Cancellations will not be refunded. Please make sure the information you enter is accurate, as it will be used for the online lisitng.

Organization Information*
Please enter your organization's information.
Organization's Name
Organization's Description 50-word max
Organization's Primary URL
Organization's Facebook
Organization's Twitter
Attendee Contact Information*
Please enter the contact information of the person you want attendees to contact for more information.
Salutation
First Name
Last Name
Job Title
Email
Phone
* Information will be used for the online listing.

Booth Quantity
Please select the number of booths your organization would like to reserve. If sharing a booth, each organization is required to complete its own registration to be listed in the Exhibitor Directory.
Number of Booths:	1 booth @ $200 2 booths @ $400 No booth, just a sponsorship Sharing a booth with a current exhibitor

Booth Contact Information
Please enter the contact information of the person responsible for the booth and any decisions about it.
Salutation
First Name
Last Name
Job Title
Email
Phone
Address
City
State
Zip

Did you participate in last year’s Summer Academy? Yes No If No, have you ever participated in a past Summer Academy? Yes No If Yes, what year(s)?

I agree that the information above is accurate and I have the authority to enter into this agreement. Please enter your name to serve as your electronic signature.