2008 WVHIMA Annual Meeting
Stonewall Jackson Resort
Roanoke, WV

Louder, Larger, Faster
May 19-21, 2008

Exhibitor Registration Form

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Exhibitor Booth Registration Form

Need to modify or cancel an existing registration?  Contact us.

I.  Correspondence Information

Please identify one individual as your company’s contact person.  All correspondence concerning your exhibitor contract and booth information will be forwarded to this individual you provide below.   

* Required information.
 

* Company Name:

* First Name:

* Last Name:

* Address 1:

Address 2:

* City:

 * State:

* Zip Code:

* Phone:

Fax: 

* E-mail:

Website:

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II.  Booth Information

Please see rules and regulations for booth specifications. 
   

Will you be using a table top display?

Yes No
   

Will you need Internet access?

Yes No
   

Booth Cost:
Registration Type Date Price

Early Registration

Prior to April 1

$500 per booth space

Regular Registration

April 2-April 15

$550 per booth space

Late Registration

After April 15th

$600 per booth space

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III.  Sponsorship Information
 

Sponsorship by vendor supporters is always appreciated. If you would like to sponsor in addition to Booth Rental, we offer the following options.

Level of Sponsorship:

  Description

Price
Gold

Name on website with description of services and contact information, Signage at convention showing sponsorship

 $1000
     
Silver Name on website with a description of service $500
     
Copper Name on website $250

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IV. Program Listing

Please list information as it is to appear in the WVHIMA Program Book.  
 

Use information in Correspondence Information.
 

                     or provide below

Company Name:

 First Name:

 Last Name:

 Address 1:

Address 2:

 City:

  State:

 Zip Code:

 Phone:

Fax: 

 E-mail:
   

Product/Service Description:

 

Describe your company, products or services: 
(50 - 75 words max)

Product/Service Type:

 

Please check the category(s) where you would like to have your company listed in the program by service categories.
 
Chargemaster system/services
Chart products
Chart tracking software
Clinical information systems
Coding products
Coding services
Coding software
Compliance
Consulting
Deficiency software
Digital dictation/voice recognition software
Disclosure systems/services
Electronic health record software/services
Filing equipment/systems
Imaging solutions
Interim/contract management
Master patient index software/services
Microfilm supplies/equipment
Office equipment/furniture
Outsourcing
Patient tracking systems
Personal health records
Privacy solutions
Professional services
Publisher/publications
Quality management software/services
Recruitment/job placement
Registry software/services
Reimbursement services
Release of information services
Security solutions
Software/software development
Training/education
Transcription services
Transcription software
Utilization management software/services

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V.  Attendance

* Attendees:

How many company attendees will be present at the conference?   

 
 

Name Badges:

Please list the participants that will require name badges.

 

Name

Name
Name
Name
Name
 

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VI. Sponsorship Agreement

We hereby make application for exhibit space(s) as indicated for our use at the West Virginia Health Information Management Association’s Annual Convention to be held on May 19-21, 2008 at Stonewall Jackson Resort, Roanoke, WV.

We agree to abide by the exhibit rules and regulations of WVHIMA and to all conditions under which exhibit space at Stonewall Jackson Resort as arranged by WVHIMA.

We understand that designation of our space will be assigned to us, after payment has been received and upon arrival at the convention center by WVHIMA.

It is further understood that all space not paid for by April 20, 2007 is subject to be re-assigned at the discretion of WVHIMA. 

We have reviewed and acknowledge acceptance of the terms and conditions which includes the cancellation policy, insufficient check funds policy, and the credit card terms and conditions.

*

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VII. Questions or Special Requirements

Do you have a question or comment?  Please enter below and we will contact you.
   

WVHIMA looks forward to your participation in this year’s convention!!

 If you would like a copy of this completed registration form,
please print a copy before you select "continue".

Payment options include: Credit card and check


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Updated: 05/09/2008
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