Organization Full Address (Include Street Address, City, State, Country) *
Your answer
Organization Phone Number *
Your answer
Organization Website *
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Description of Organization (To be used at the Symposium virtual booth for participants to learn more about your organization) *
Your answer
Contact Person *
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Contact Person's Email *
Your answer
Contact Person's Phone Number *
Your answer
Organization Representative #1, Attending the Symposum *
Your answer
Organization Representative #1 Email *
Your answer
Organization Representative #2, Attending the Symposium
Your answer
Organization Representataive #2 Email
Your answer
Additional Representative's Names & Emails
Your answer
Number of Virtual Meeting Rooms. You can have one room per representative; each room can allow 8 participants to video chat with the representative. *
If you answered "Other" to the previous question, state the number of meeting rooms you are requesting.
Your answer
Are you interested in donating to the daily raffle? *
If you answered "yes" to the previous question, what would you like to donate and what is the value of the item(s)?
Your answer
Are you interested in doing a live demonstration or information session with participants during a scheduled break? *
If you answered "yest" to the previous question, what are your requested day(s)/times(s)? *We will do our best to honor your request but cannnot guarantee timing. Please check all that apply.
I agree to the following: *Email education@integrativeot.org a company logo, *Email education@integrativeot.org a welcome video if you choose to use one, *Pay the Exhibitor fee of $200 via PayPal. Payment guarantees a virtual booth at the event, *Complete a dry run with Integrative Education on the FLOOR prior to the Symposium, *Have at least one representative available at the virtual booth at the Symposium on February 26 -27, 2021 from 8:00 am – 8:30 AM CST, 10:00 am – 10:30 am CST, 12:00 pm – 1:00 pm CST, and 2:30 pm – 3:00 pm CST *
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