Integrative Education Exhibitor Agreement Form  
Thank you for your interest in being an exhibitor at the 2021 Integrative Education Symposium!  Please fill out this form and we will confirm your participation with the contact person listed.  If you have any questions, contact Heather Schmidt at education@integrativeot.org.  Thank you!
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Organization Name *
Organization Full Address (Include Street Address, City, State, Country) *
Organization Phone Number *
Organization Website *
Description of Organization (To be used at the Symposium virtual booth for participants to learn more about your organization) *
Contact Person *
Contact Person's Email *
Contact Person's Phone Number *
Organization Representative #1, Attending the Symposum *
Organization Representative #1 Email *
Organization Representative #2, Attending the Symposium
Organization Representataive #2 Email
Additional Representative's Names & Emails
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.
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)?
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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