National Association of Computer Consultant Businesses (NACCB)

Exhibit Space Application Iowa Mental Health Counselors Association 11th Annual Conference & Exhibition Holiday Inn Des Moines – Airport Conference Center Hotel, Des Moines, IA Show Dates: May 4-5, 2017

Exhibitor Information: Please provide the following organization information exactly as you would like it to appear at the conference. (To complete this form electronically, “tab” between fields and email to [email protected], or you may fill it out and mail it to the address below.)

Organization Name:

Address:

City, State, Zip:

Main Phone : Web Site:

Fax: Email (i.e., [email protected]):

Description of Product or Service: IMHCA reserves the right to determine eligibility of any company or product to participate in the show. To help us determine your eligibility, please describe the product or service you will be exhibiting.

Exhibit Contact: Email:

Space Selection: Exhibitors will be assigned tables in the order their application and payment are received, with priority placement given to Sponsors. Qty Table(s) Each table includes one draped 6’ table, two chairs, two exhibit personnel badges, and a listing in the program. Rates are $175/table for two days or $100/table for one day. Please indicate your preference below:

Full Conference (2 days; $175) Thursday, May 4 ($100) Friday, May 5 ($100)

Payment Amount: $

Payment Type (Payable to IMHCA): Check Money Order Or pay online at https://imhca.net!

Questions? Send Payments to: Lindsay Kalvig, LMHC, CADC Iowa Mental Health Counselors Association IMHCA Conference Committee c/o Lindsay Stack Email: [email protected] 313 Tumbleweed Trail Waverly, IA 50677