51st Annual Convention & Expo Sponsor, Exhibitor & Advertiser Registration Form

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General Information

WHEN: Monday, October 26, 2026

8:00 a.m. - 9:00 a.m. Registration
8:00 a.m. - 4:00 p.m. Exhibit Tables Open
9:00 a.m. - 5:00 p.m. Convention (Join us for a day of learning, networking and celebrating the human services sector!)

WHERE: The Providers’ Council’s Convention & Expo will take place IN-PERSON at the Marriott Copley Place Hotel, Boston.

I am registering as a(n):

Please enter the contact information for the primary contact within your organization who should receive information related to this event.

First Name:

Last Name:

Email:

Pronouns

If your preferred pronouns are not listed, please select "Not listed" and send a message to convention@providers.org

Phone:

Did you Sponsor, Exhibit, or Advertise at any of the recent (last 3 years) Providers' Council Convention & Expos?

YesNo

Agency Information

Is your organization a Providers' Council Provider Member or Associate Member?

Agency/Company Name:

If your organization begins with "The", please scroll to "T".

Non-Member Agency/Company Name:

Website

Street Address

Apt/Suite

City/Town

State

Zip Code

Phone

Sponsor Registration

Please select your sponsorship level:

Diamond (Presenting Sponsor): $25,000

EXCLUSIVE OPPORTUNITY

- On-stage recognition during opening and closing remarks

- Opportunity to make remarks from the stage

- (1) PREMIER exhibit table space in high-traffic location

- Logo placement on:

-- Event website homepage

-- Registration page

-- Illumination in ballroom

-- Printed program

-- Conference bag and yearly planner

-- Table centerpieces

- Branded item inclusion in conference bag

- Full-page color ad in program book (priority placement)

- Featured social media campaign (multi-post series)

-- Get to Know your Sponsor post

-- Thank you sponsorship post

- Publicity in The Provider newspaper

- Featured in Expo Scavenger Hunt

- Two reserved VIP luncheon tables, includes 20 complimentary registrations

______________________________________________________________

Platinum (Reception Sponsor): $15,000

- On-stage recognition during opening and closing remarks

- (1) STANDARD exhibit table

- Logo placement on:

-- Website sponsor page

-- Registration page

-- Reception signage

-- Printed program

-- Conference bag

-- Table centerpieces

- Branded item inclusion in conference bag

- Full-page color ad in program book (priority placement)

- Featured social media campaign (multi-post series)

-- Get to Know your Sponsor post

-- Thank you sponsorship post

- Publicity in The Provider newspaper

- One reserved VIP luncheon table, includes 10 complimentary registrations

______________________________________________________________

Gold (Keynote Sponsor): $10,000

- On-stage recognition during opening and closing remarks

- Logo placement on:

-- Website sponsor page

-- Printed program

-- Table centerpieces

-- Appropriate event signage

- Full-page Color ad in program book

- Featured social media campaign (multi-post series)

-- Get to Know your Sponsor post

-- Thank you sponsorship post

- Publicity in The Provider newspaper

- One reserved VIP luncheon table, includes 10 complimentary registrations

______________________________________________________________

Sapphire (Technology Sponsor): $7,500

- Logo placement on:

-- Signage near all AV equipment in workshop rooms

-- Website sponsor page

-- Table centerpieces

- Full-page B&W ad in program book

- Program book recognition

- Dedicated social media feature

- Publicity in The Provider newspaper

- Complimentary registrations: 6

______________________________________________________________

Silver (Luncheon Sponsor): $5,000

- Logo placement on:

-- Signage at luncheon

-- Website sponsor page

-- Appropriate event signage

- Half-page B&W ad in program book

- Program book recognition

- Social media mention

- Publicity in The Provider newspaper

- Complimentary registrations: 4

______________________________________________________________

Bronze (Breakfast Sponsor): $3,000

- Logo placement on:

-- Signage at breakfast

-- Website sponsor page

- Listing in program book

- Social media mention

- Listing in The Provider newspaper

- Complimentary registrations: 2

______________________________________________________________

Garnet (Network Sponsor - 3 Available): $2,500

- Opportunity to introduce designated networking session

- Listing in program book

- Website sponsor listing

- Appropriate event signage

- Social media mention

______________________________________________________________

Community Sponsor: $1,000

- Listing in program book

- Website sponsor listing

- Appropriate event signage

______________________________________________________________

Friend Sponsor: $500

- Listing in program book

- Website sponsor listing

*All advertisements and logos must be submitted by August 31.

Diamond

Thank you for sponsoring at the Diamond level! You receive (20) complimentary tickets to the Convention & Expo as well as (2) reserved lunch tables. You also receive one PREMIER Expo table. Please reach out to Ann Schuler for more information regarding the Expo.

Please proceed below to complete your complimentary ticket registration.

Would you like to donate your tickets to help more human service professionals attend the Convention?

Would you like to register your staff now? Please only register your staff if you have a COMPLETE list of registrants.

Yes, I want to proceed to registration. No, I will email a attendee list to ann@providers.org no later than August 31.

Platinum

Thank you for sponsoring at the Platinum level! You receive (10) complimentary tickets to the Convention & Expo as well as (1) reserved lunch table. You also receive one Standard Expo table. Please reach out to Ann Schuler for more information regarding the Expo.

Please proceed below to complete your complimentary ticket registration.

Would you like to donate your tickets to help more human service professionals attend the Convention?

Would you like to register your staff now? Please only register your staff if you have a COMPLETE list of registrants.

Yes, I want to proceed to registration. No, I will email a attendee list to convention@providers.org no later than August 31.

Gold

Thank you for sponsoring at the Gold level! You receive (10) complimentary tickets to the Convention & Expo as well as (1) reserved lunch table.

Please proceed below to complete your complimentary ticket registration.

Would you like to donate your tickets to help more human service professionals attend the Convention?

Would you like to register your staff now? Please only register your staff if you have a COMPLETE list of registrants.

Yes, I want to proceed to registration. No, I will email a attendee list to convention@providers.org no later than August 31.

Sapphire

Thank you for sponsoring at the Sapphire level! You receive (6) complimentary tickets to the Convention & Expo.

Please proceed below to complete your complimentary ticket registration.

Would you like to donate your tickets to help more human service professionals attend the Convention?

Would you like to register your staff now? Please only register your staff if you have a COMPLETE list of registrants.

Yes, I want to proceed to registration. No, I will email a attendee list to convention@providers.org no later than August 31.

Silver

Thank you for sponsoring at the Silver level! You receive (4) complimentary tickets to the Convention & Expo.

Please proceed below to complete your complimentary ticket registration.

Would you like to donate your tickets to help more human service professionals attend the Convention?

Would you like to register your staff now? Please only register your staff if you have a COMPLETE list of registrants.

Yes, I want to proceed to registration. No, I will email a attendee list to convention@providers.org no later than August 31.

Bronze

Thank you for sponsoring at the Bronze level! You receive (2) complimentary tickets to the Convention & Expo.

Please proceed below to complete your complimentary ticket registration.

Would you like to donate your tickets to help more human service professionals attend the Convention?

Would you like to register your staff now? Please only register your staff if you have a COMPLETE list of registrants.

Yes, I want to proceed to registration.No, I will email a attendee list to convention@providers.org no later than August 31.

Group Registration Information

To register multiple people, select "add another registration" at the bottom of the page.

**Please remember to register yourself if you are attending.**

First Name:

Last Name:

Job Title:

Pronouns:

If your preferred pronouns are not listed, please send a message to convention@providers.org

Email Address (must be the email address of the person being registered).

You will receive a confirmation email with your individual registration information.

License Information:

License Number (if applicable):

Lunch choice

Do you have any dietary considerations or severe food allergies we should know about?

Please add any dietary restrictions or severe food allergies:

Do you need any reasonable accommodations?

Reasonable accommodations requested:

Please note that requests for interpreting services must be submitted by September 15, 2026.

To register another person, please click "Add another registration" below.

Would you also like to ADD-ON an EXHIBIT TABLE or ADVERTISEMENT at the Convention & Expo?

Exhibit tableAdvertise

Exhibitor Registration

Which Exhibitor package are you purchasing?

PREMIER ($1675) - Providers' Council Member - One 8 ft. by 3 ft. exhibit table, larger than the standard 

- Priority table placement in high-traffic areas 

- Wi-Fi/Electrical included 

- Two complimentary lunch tickets 

- Admission for (2) additional exhibit staff (lunch not included; can purchase as add-on)

- 1/2 B&W advertisement in program book

- Logo and link to company website on conference webpage

- Listing with company information in the Exhibitors’ Directory of program book

- “Get to Know” your Premier Exhibitor's social media post (pre-event)

- Combined social media shoutout (post event)

- Acknowledgment in The Provider newspaper  ____________________________________________________________________________ STANDARD ($875) - Providers' Council Member - One 6 ft. by 3 ft. exhibition table 

- Wi-Fi/Electrical included

- Admission for (2) exhibit staff (lunch not included; can purchase as add-on) 

- Listing on conference webpage 

- Listing in the Exhibitors’ Directory of program book  

- Combined social media shoutout (post event)

Which Exhibitor package are you purchasing?

PREMIER ($2475) - Not Yet Member - One 8 ft. by 3 ft. exhibit table, larger than the standard 

- Priority table placement in high-traffic areas 

- Wi-Fi/Electrical included 

- Two complimentary lunch tickets 

- Admission for (2) additional exhibit staff (lunch not included; can purchase as add-on)

- 1/2 B&W advertisement in program book

- Logo and link to company website on conference webpage

- Listing with company information in the Exhibitors’ Directory of program book

- “Get to Know” your Premier Exhibitor's social media post (pre-event)

- Combined social media shoutout (post event)

- Acknowledgment in The Provider newspaper  ____________________________________________________________________________ STANDARD ($1275) - Not Yet Member - One 6 ft. by 3 ft. exhibition table 

- Wi-Fi/Electrical included

- Admission for (2) exhibit staff (lunch not included; can purchase as add-on) 

- Listing on conference webpage 

- Listing in the Exhibitors’ Directory of program book  

- Combined social media shoutout (post event)

Desired Table/Space Location

Table location will be assigned on a first paid, first-served basis. Table 1-36 reserved for Premier Exhibitors.

Second Choice for Table/Space Location

Third Choice for Table/Space Location

Please read the below terms to exhibiting with the Providers' Council at the 50th Annual Convention & Expo:

On the day of the Expo, exhibitors agree to:

- Arrive no later than 7:30 a.m. to prepare for the 8 a.m. Expo opening;

- Have available and distribute sufficient copies of a general brochure or similar literature to Expo visitors;

- Supply any audio-visual or similar equipment that is necessary;

- Staff the exhibit continuously from 8 a.m. to 4 p.m.;

- Only display materials which are fire-proof and conform to city, state and national fire prevention codes;

- Fit exhibits in the space provided (6 ft. by 3 ft. for standard exhibitors; 8 ft. by 3 ft. for premier exhibitors);

If your exhibit does not fit in the allotted space, the Providers' Council reserves the right to relocate you;

- The Providers' Council has exclusive relationships with several Endorsed Business Partners. Companies providing competing products or services are ineligible to participate in this event. Contact Ann Schuler at the Council with any questions regarding eligibility;

- Hold harmless the Providers' Council for any loss, theft or damage to the property of the exhibitor, their employees or designees, as well as any damage to property or injury to persons during the term of this agreement from any cause whatsoever by reason of the use or occupancy of the exhibit space by the exhibitors or their assigns, and the exhibitor shall indemnify and hold harmless the Council from all liability which might ensue from any cause.

I agree to the above terms.

NEW this year - Expo Scavenger Hunt!

Would you like to participate in Expo Scavenger Hunt? Your table will be added to a list of clues provided to every attendee. To be eligible for prizes at the end of the convention, attendees must answer the questions correctly. Names will be drawn at random and all answers must be answered correctly.

We ask that you please send a fun fact, general information, or piece of trivia to convention@providers.org if you want to foster a specific conversation with attendees. Examples include:

- What is your most popular product/services; -- When was your company/organization founded; -- What is your organization’s/ company’s slogan; -- What is the biggest challenge your customers face that you help solve

Please note that if you do not submit any information, Council staff will create a general clue based on available information.

If you would like to participate, we do ask Premier exhibitors to contribute a prize of any size: for example, gift cards, swag, gift baskets, electronics, sports tickets, etc.

For any questions about Expo BINGO, please email Ann Schuler.

Yes, I would like to participate in Expo Scavenger Hunt.No, I would not like to participate.

Additional Exhibitor Needs

No additional needsElectrical outletWi-FiElectrical outlet and WiFi access is included in your exhibitor package. For table planning purposes, please indicate your preferences.

Exhibitor Staff Information

Please share the contact information of any other individual(s) who will be attending the in-person Convention & Expo on behalf of your company/agency.

Click "add another response" below to add more names.

Who will physically be staffing your exhibit table?

I will be staffing the exhibit table, and I am the only person staffing it. I will be staffing the exhibit table, and I will have others from my agency as well. I will NOT be staffing the exhibit table, others from my agency will be at the table.

Additional Attendees

First Name

Last Name

Pronouns

If your preferred pronouns are not listed, please send a message to convention@providers.org

To register another person, please click "Add another registration" below.

Premier exhibitors receive two complimentary lunch tickets and up to 4 people may staff your table. Standard exhibitors may have up to 2 people staff the expo table and lunch tickets must be purchased separately.

ADD ON: Lunch tickets for Standard Exhibitors

$75 per person

ADD ON: Lunch tickets for Premier Exhibitors *Note that 2 lunch tickets are automatically included with your Premier table. Please only select additional lunch tickets if needed for additional table staff.

$75 per person

1st Premier Exhibitor Lunch Selection

2nd Premier Exhibitor Lunch Selection

1st Additional Lunch Selection

2nd Additional Lunch Selection

Would you also like to ADD-ON an SPONSORSHIP or ADVERTISEMENT at the Convention & Expo?

SponsorshipAdvertiseIf you have already registered as a sponsor or advertiser, you do not need to register again.

Advertiser Registration

Please choose your Advertisement size:

Full Page COLOR Advertisement $825 (Providers' Council Member)Full Page B&W (7½ w x 10 h) $425 (Providers' Council Member)Half Page B&W (7½ w x 5 h) $300 (Providers' Council Member)Quarter Page B&W (7½ w x 2½ h) $200 (Providers' Council Member)Quarter Page B&W (3¾ w x 5 h) $200 (Providers' Council Member)Black and white .pdf files (unless purchasing full page color ad). If you are sending a .pdf file, please be sure the fonts are embedded. All artwork must be sent to convention@providers.org by August 31, 2026.

Full Page COLOR Advertisement $1075 (Not yet a member)Full Page B&W (7½ w x 10 h) $675 (Not yet a member)Half Page B&W (7½ w x 5 h) $550 (Not yet a member)Quarter Page B&W (7½ w x 2½ h) $450 (Not yet a member)Quarter Page B&W (3¾ w x 5 h) $450 (Not yet a member)Black and white .pdf files (unless purchasing full page color ad). If you are sending a .pdf file, please be sure the fonts are embedded. All artwork must be sent to convention@providers.org by August 31, 2026.

Would you also like to ADD-ON an SPONSORSHIP or EXHIBIT TABLE at the Convention & Expo?

SponsorshipExhibit TableIf you have already registered as a sponsor or exhibitor, you do not need to register again.

Sponsor/Exhibitor Information

Please upload a copy of your organization's logo.
If you do not upload one now, please send one to convention@providers.org as soon as possible.

Please share a 25-word description of your organization's programs and services.

Please note the deadline to submit all information related to your sponsorship or exhibitor opportunity is August 31. Please email convention@providers.org with any questions.

Please proceed to the next page to complete the additional sponsor and exhibitor opportunities selected.

Additional Opportunity Registration

Sponsor Registration

Please select your sponsorship level:

Diamond (Presenting Sponsor): $25,000

EXCLUSIVE OPPORTUNITY

- On-stage recognition during opening and closing remarks

- Opportunity to make remarks from the stage

- (1) PREMIER exhibit table space in high-traffic location

- Logo placement on:

-- Event website homepage

-- Registration page

-- Illumination in ballroom

-- Printed program

-- Conference bag and yearly planner

-- Table centerpieces

- Branded item inclusion in conference bag

- Full-page color ad in program book (priority placement)

- Featured social media campaign (multi-post series)

-- Get to Know your Sponsor post

-- Thank you sponsorship post

- Publicity in The Provider newspaper

- Featured in Expo Scavenger Hunt

- Two reserved VIP luncheon tables, includes 20 complimentary registrations

______________________________________________________________

Platinum (Reception Sponsor): $15,000

- On-stage recognition during opening and closing remarks

- (1) STANDARD exhibit table

- Logo placement on:

-- Website sponsor page

-- Registration page

-- Reception signage

-- Printed program

-- Conference bag

-- Table centerpieces

- Branded item inclusion in conference bag

- Full-page color ad in program book (priority placement)

- Featured social media campaign (multi-post series)

-- Get to Know your Sponsor post

-- Thank you sponsorship post

- Publicity in The Provider newspaper

- One reserved VIP luncheon table, includes 10 complimentary registrations

______________________________________________________________

Gold (Keynote Sponsor): $10,000

- On-stage recognition during opening and closing remarks

- Logo placement on:

-- Website sponsor page

-- Printed program

-- Table centerpieces

-- Appropriate event signage

- Full-page Color ad in program book

- Featured social media campaign (multi-post series)

-- Get to Know your Sponsor post

-- Thank you sponsorship post

- Publicity in The Provider newspaper

- One reserved VIP luncheon table, includes 10 complimentary registrations

______________________________________________________________

Sapphire (Technology Sponsor): $7,500

- Logo placement on:

-- Signage near all AV equipment in workshop rooms

-- Website sponsor page

-- Table centerpieces

- Full-page B&W ad in program book

- Program book recognition

- Dedicated social media feature

- Publicity in The Provider newspaper

- Complimentary registrations: 6

______________________________________________________________

Silver (Luncheon Sponsor): $5,000

- Logo placement on:

-- Signage at luncheon

-- Website sponsor page

-- Appropriate event signage

- Half-page B&W ad in program book

- Program book recognition

- Social media mention

- Publicity in The Provider newspaper

- Complimentary registrations: 4

______________________________________________________________

Bronze (Breakfast Sponsor): $3,000

- Logo placement on:

-- Signage at breakfast

-- Website sponsor page

- Listing in program book

- Social media mention

- Listing in The Provider newspaper

- Complimentary registrations: 2

______________________________________________________________

Garnet (Network Sponsor - 3 Available): $2,500

- Opportunity to introduce designated networking session

- Listing in program book

- Website sponsor listing

- Appropriate event signage

- Social media mention

______________________________________________________________

Community Sponsor: $1,000

- Listing in program book

- Website sponsor listing

- Appropriate event signage

______________________________________________________________

Friend Sponsor: $500

- Listing in program book

- Website sponsor listing

*All advertisements and logos must be submitted by August 31.

Diamond

Would you like to donate your tickets to help more human service professionals attend the Convention?

Would you like to register your staff now? Please only register your staff if you have a COMPLETE list of registrants.

Yes, I want to proceed to registration. No, I will email a attendee list to ann@providers.org no later than August 31.

Platinum

Would you like to donate your tickets to help more human service professionals attend the Convention?

Would you like to register your staff now? Please only register your staff if you have a COMPLETE list of registrants.

Yes, I want to proceed to registration. No, I will email a attendee list to convention@providers.org no later than August 31.

Gold

Would you like to donate your tickets to help more human service professionals attend the Convention?

Would you like to register your staff now? Please only register your staff if you have a COMPLETE list of registrants.

Yes, I want to proceed to registration. No, I will email a attendee list to convention@providers.org no later than August 31.

Sapphire

Thank you for sponsoring at the Sapphire level! You receive (6) complimentary tickets to the Convention & Expo.

Please proceed below to complete your complimentary ticket registration.

Would you like to donate your tickets to help more human service professionals attend the Convention?

Would you like to register your staff now? Please only register your staff if you have a COMPLETE list of registrants.

Yes, I want to proceed to registration. No, I will email a attendee list to convention@providers.org no later than August 31.

Silver

Thank you for sponsoring at the Silver level! You receive (4) complimentary tickets to the Convention & Expo.

Please proceed below to complete your complimentary ticket registration.

Would you like to donate your tickets to help more human service professionals attend the Convention?

Would you like to register your staff now? Please only register your staff if you have a COMPLETE list of registrants.

Yes, I want to proceed to registration. No, I will email a attendee list to convention@providers.org no later than August 31.

Bronze

Thank you for sponsoring at the Bronze level! You receive (2) complimentary tickets to the Convention & Expo.

Please proceed below to complete your complimentary ticket registration.

Would you like to donate your tickets to help more human service professionals attend the Convention?

Would you like to register your staff now? Please only register your staff if you have a COMPLETE list of registrants.

Yes, I want to proceed to registration.No, I will email a attendee list to convention@providers.org no later than August 31.

Group Registration Information

To register multiple people, select "add another registration" at the bottom of the page.

**Please remember to register yourself if you are attending.**

First Name:

Last Name:

Job Title:

Pronouns:

If your preferred pronouns are not listed, please send a message to convention@providers.org

Email Address (must be the email address of the person being registered).

You will receive a confirmation email with your individual registration information.

License Information:

License Number (if applicable):

Lunch choice

Do you have any dietary considerations or severe food allergies we should know about?

Please add any dietary restrictions or severe food allergies:

Do you need any reasonable accommodations?

Reasonable accommodations requested:

Please note that requests for interpreting services must be submitted by September 15, 2026.

To register another person, please click "Add another registration" below.

Exhibitor Registration

Which Exhibitor package are you purchasing?

PREMIER ($1675) - Providers' Council Member - One 8 ft. by 3 ft. exhibit table, larger than the standard 

- Priority table placement in high-traffic areas 

- Wi-Fi/Electrical included 

- Two complimentary lunch tickets 

- Admission for (2) additional exhibit staff (lunch not included; can purchase as add-on)

- 1/2 B&W advertisement in program book

- Logo and link to company website on conference webpage

- Listing with company information in the Exhibitors’ Directory of program book

- “Get to Know” your Premier Exhibitor's social media post (pre-event)

- Combined social media shoutout (post event)

- Wi-Fi/Electrical included

- Admission for (2) exhibit staff (lunch not included; can purchase as add-on) 

- Listing on conference webpage 

- Listing in the Exhibitors’ Directory of program book  

- Combined social media shoutout (post event)

Which Exhibitor package are you purchasing?

PREMIER ($2475) - Not Yet Member - One 8 ft. by 3 ft. exhibit table, larger than the standard 

- Priority table placement in high-traffic areas 

- Wi-Fi/Electrical included 

- Two complimentary lunch tickets 

- Admission for (2) additional exhibit staff (lunch not included; can purchase as add-on)

- 1/2 B&W advertisement in program book

- Logo and link to company website on conference webpage

- Listing with company information in the Exhibitors’ Directory of program book

- “Get to Know” your Premier Exhibitor's social media post (pre-event)

- Combined social media shoutout (post event)

- Wi-Fi/Electrical included

- Admission for (2) exhibit staff (lunch not included; can purchase as add-on) 

- Listing on conference webpage 

- Listing in the Exhibitors’ Directory of program book  

- Combined social media shoutout (post event)

Desired Table/Space Location

Table location will be assigned on a first paid, first-served basis. Table 1-36 reserved for Premier Exhibitors.

Second Choice for Table/Space Location

Third Choice for Table/Space Location

Please read the below terms to exhibiting with the Providers' Council at the 50th Annual Convention & Expo:

On the day of the Expo, exhibitors agree to:

- Arrive no later than 7:30 a.m. to prepare for the 8 a.m. Expo opening;

- Have available and distribute sufficient copies of a general brochure or similar literature to Expo visitors;

- Supply any audio-visual or similar equipment that is necessary;

- Staff the exhibit continuously from 8 a.m. to 4 p.m.;

- Only display materials which are fire-proof and conform to city, state and national fire prevention codes;

- Fit exhibits in the space provided (6 ft. by 3 ft. for standard exhibitors; 8 ft. by 3 ft. for premier exhibitors);

If your exhibit does not fit in the allotted space, the Providers' Council reserves the right to relocate you;

I agree to the above terms.

NEW this year - Expo Scavenger Hunt!

We ask that you please send a fun fact, general information, or piece of trivia to convention@providers.org if you want to foster a specific conversation with attendees. Examples include:

Please note that if you do not submit any information, Council staff will create a general clue based on available information.

If you would like to participate, we do ask Premier exhibitors to contribute a prize of any size: for example, gift cards, swag, gift baskets, electronics, sports tickets, etc.

For any questions about Expo BINGO, please email Ann Schuler.

Yes, I would like to participate in Expo Scavenger Hunt.No, I would not like to participate.

Additional Exhibitor Needs

No additional needsElectrical outletWi-FiElectrical outlet and WiFi access is included in your exhibitor package. For table planning purposes, please indicate your preferences.

Exhibitor Staff Information

Please share the contact information of any other individual(s) who will be attending the in-person Convention & Expo on behalf of your company/agency.

Click "add another response" below to add more names.

Who will physically be staffing your exhibit table?

Additional Attendees

First Name

Last Name

Pronouns

If your preferred pronouns are not listed, please send a message to convention@providers.org

To register another person, please click "Add another registration" below.

ADD ON: Lunch tickets for Standard Exhibitors

$75 per person

1st Premier Exhibitor Lunch Selection

2nd Premier Exhibitor Lunch Selection

1st Additional Lunch Selection

2nd Additional Lunch Selection

Please proceed to the next page to enter payment information.

Payment

Sponsorship Amount Due: $

Exhibitor and/or Advertiser Amount Due: $

Payment Options:

Please note that paying by credit card will incur a 3.5% convenience fee.

Invoice Request

If you would like a formal invoice, please check this box. This invoice will be emailed to the identified point of contact listed above.
Note: An automatic confirmation email will be sent upon submission of this form. This email indicates the amount due, which may serve as your invoice.

Total Amount Due: $

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