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Register your booth for the March 22 & 23, 2018 Conference

2018 Exhibitor Registration Form for download & mailing

Contact Information
Exhibit Booth Amount
$

* Some exhibitors give additional funds to help the Brain Injury Alliance to support its programs. If you wish to do so, put the additional amount in the box below. If you would like to be listed as an official sponsor of the BIA-NE, please the Sponsorship page. We are so appreciative of your gift. You will receive a letter to keep with your tax records for this contribution.


Please write a 50-word description of your business to be used in promotion. If you want to use the previous year's description, please put that.

Electricity
Do you require electricity?
Booth Conditions, Rules and Regulations

Booth Conditions, Rules and Regulations: The Alliance reserves the right to refuse the application of any party. The exhibitor agrees to make payment for space as outlined in this agreement. The BIA-NE shall determine the allocation of area and position of space. In no event shall the Alliance be responsible for any loss of or damage to exhibitor property.

Do not use hyphens or spaces in credit card number.
Credit Card Information
Visa MasterCard American Express Discover Diners Club
Your total payment will be