Health & Safety Conference: Vendor Registration

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

The 2021-2022 ESC-2 School Health & Safety Conference is scheduled for Thursday, November 4th.
The deadline to submit a breakout session proposal (optional) is September 3, 2021.
REGISTRATION and PAYMENT DEADLINE is October 1, 2021. Payment must be postmarked by October 1, 2021.
Accepted payments: Credit/Debit, Pay pal, Check

Email *

Vendor Information

Note: Enter your responses exactly as you would like them to appear, either digitally or in print, on conference materials.

Company Name *

Company Primary Contact *

First and Last Name

Primary Contact Title *

Company Street Address *

City *

State *

Zip *

Contact Phone Number *

(including area code)

Company Website (URL)

Type of Company/Industry *

Brief Company Description *

approximately 250 words or less

Vendor agrees to provide door prize for participant drawings during the event. *

You may bring this to registration or mail prior to the event. Please no alcoholic drinks or tobacco products.

Yes

Booth Information

Vendors must provide their own extension cords, power strips, and/or surge protectors. Booth assignments are considered based on payment receipt date and the size of the booth selected.

Indicate the type of equipment or displays needed: *

Tabletop Display Only

Floor Display

Access to Electricity

Other:

Required

Select the appropriate size booth for your equipment and displays

6 ft Tabletop Exhibit- $250.00

6 ft Tabletop Exhibit- Non-profit - Free (limited number of spots)

If sharing a booth with another company, the vendor submitting the registration form will be responsible for full payment.

Name of company you are sharing booth with (if applicable).

Will your organization be able to provide CNEs or CEUs?

Yes

Clear selection

Vendor Sponsorship (Optional)

Our company agrees to provide the following through a vendor sponsorship for the Education Service Center, Region 2 Health & Safety Conference on November 4, 2021. I am an authorized representative that can commit my company to providing these items. Education Service Center, Region 2 will list sponsor level membership in the digital conference agenda, conference website, and on custom conference posters during the event.

NO REFUNDS WILL BE ISSUED AFTER OCTOBER 15, 2021.

PLATINUM

$400- Advertisement throughout the event; Personalized social media release; Breakout session (with ESC 2 Committee Approval)

GOLD

$300- Advertisement throughout the event; Personalized social media release

SILVER

$200 - Advertisement throughout the event

Item Sponsorship

Conference Swag Bags (3 spots available includes Platinum sponsorship)

Conference Snack Break ($200- 2 spots available includes Silver sponsorship)

Conference Breakfast Sponsor ($300- 1 spots available includes Gold sponsorship)

Clear form

Never submit passwords through Google Forms.

This form was created inside of Education Service Center, Region 2. Report Abuse

Forms