Louisiana Nursing Home Assoc

2010 Annual Convention and Trade Show

Exhibitor Registration

Exhibitor Information

Company

Contact Name

Address

City State Zip Code

Phone

Fax

Email Address

Product or Service

Golf Tournament (# players @ $100 each)

Choice of Booth Space (see diagram) to be assigned on a first-paid basis. Please provide at least three choices.

1st:

2nd:

3rd:

Electricity:

Names for Badges:

Name:

Name

Name:

Sponsorships:

Company Name: (exactly how you would like it to appear on printed materials

I would like to sponsor the following event(s)::

  Golf Hole Sponsorship - $200
  Breakfast Club - $800
  Opening Party - $2,000
  Education Session - $1,500
  Exhibit Hall Lunch - $3,500
  President`s Reception - $4,500
  Awards Luncheon - $2,500
  Closing Party - $2,000

Sub Total:

Golf Registration

Player #1:

Name:

Golf Handicap:

Pairing Request:

Player #2

Player Name:

Golf Handicap:

Pairing Request:

Player #3

Player Name:

Golf Handicap:

Pairing Request:

Player #4

Player Name:

Golf Handicap:

Pairing Request:

Player #5

Player Name:

Golf Handicap:

Pairing Request:

Player #6

Player Name

Golf Handicap:

Pairing Request:

Make check payable to:

Louisiana Nursing Home Association

7844 Office Park Blvd.

Baton Rouge, LA 70809

225.927.5642

Please indicate on your check that you are paying for an online registration.

Total Amount Due:

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Items in RED are required.