TxHIMA | Texas Health Information Management Association

	2008 TxHIMA Annual Convention Exhibitor Registration

I. Correspondence Information

Please identify one individual as your company’s contact person. ALL mailing concerning your exhibitor contract and booth information will be mailed to this individual at the address you provide below.

* Required information.

* Company Name:

Corporate Member:

Yes, I am a TxHIMA Corporate Member
No, I am not currently a TxHIMA Corporate Member.

* First Name:

* Last Name:

* Address 1:

Address 2:

* City:

* State:

* Zip Code:

* Phone:

Fax:

* E-mail:

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II. Booth Information

Booth Selection:

When selecting booth space, please refer to the floor plan and note the booths that are already reserved. Designate your preferences by indicating the booth number below. Booths will be assigned on a first-come, first-serve basis.

Please contact the TxHIMA Meeting Planner, Cherry Kay Abel
(512-392-4716), prior to your booth selections to verify availability.

1st choice booth #
2nd choice booth #
3rd choice booth #

Booth Pricing:

	Early Registration	Corporate Early Registration	Regular Registration	Corporate Regular Registration
	By 12/31/07	By 12/31/07
Single	$1000	$850	$1250	$1000
Double	$1750	$1500	$2250	$1750

Cancellations received prior to February 1, 2008, will receive a refund of fees paid less a $250 handling charge. Cancellations made after February 1, 2008, will forfeit the entire fee.

III. Sponsorship Information

Please indicate the sponsorship and fill in the amount to be donated below.

Level of Sponsorship:

Breaks	$
Networking Lunch	$
Tote Bags	$
T-shirts	$
Lanyards	$
President's Reception	$
President's Entertainment	$
Exhibit Hall Entry Way	$
Grand Prize Drawing	$
Other - Please indicate type of sponsorship:

Ad in Convention Program

Note: Ad deadline is March 16, 2008

$250 full page (8 1/2 x 11) Cover - Full page ads only

$175 half page

$150 quarter page

$900 inside front

$750 inside back

IV. Program Listing

Please list information as it is to appear in the Program Booklet or let us know if you want to use your current description and logo we have on file.

* 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)

Let us know if you want to use your current description and logo we have on file.

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

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

VI. 2008 TxHIMA Corporate Membership

Corporate Membership

Yes, I would like to be a 2008 TxHIMA Corporate Member.
No, I am not interested.

Exhibit Benefits

Discount of 10% on your exhibitor booth for conventions

Premium booth location

Corporate Member listing in the convention program book

Priority positioning in booth selection for the next year

Advertising Benefits

Company member listing with description on the TxHIMA website (50 words max) and link website link with logo

Discount of 15% on website advertising

Free 1/4 page ad in the convention program, upon submission of camera-ready artwork or suitable electronic format

Referrals from the Executive Office in response to members’ requests for services

Member Benefits

One representative on the TxHIMA mailing list for notification of all educational programs. Your representative could take advantage of our educational opportunities at the special member price.

Receive all this for only $350.00 per year.

VII. Liability Disclaimer

Exhibitor shall be fully responsible to pay for any and all damages to property owned by The Woodlands Waterway Marriott, The Woodlands, TX, its owners or managers which results from any act of omission of Exhibitor. Exhibitor agrees to defend, indemnify and hold harmless, The Woodlands Waterway Marriott, its owners, managers, officers or directors, agents, employees, subsidiaries and affiliates, from any damages or charges resulting from Exhibitor’s use of the property. Exhibitor’s liability shall include all losses, costs, damages, or expenses arising from or out of or by reason of any accident or bodily injury or other occurrences to any person or persons, including the Exhibitor, its agents, employees, and business invitees which arise from or out of Exhibitor’s occupancy and use of the exhibition premises or any part thereof.

VIII. Sponsorship Agreement

I agree to pay for the booth and/or sponsorship items listed above.

I 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.

I agree to sponsor the above noted event for members of TxHIMA, and agree to make payment in advance by credit card or check, no later than April 1st to ensure all costs associated with printing are met by TxHIMA Executive Office for this function.

IX. Questions or Comments

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

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