TxHIMA | Texas Health Information Management Association

	2009 TxHIMA Annual Meeting & Convention June 28-30, 2009 Hyatt Regency Dallas Dallas, TX
	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
	On or Before 1/31/09	On or Before 1/31/09	After 1/31/09	After 1/31/09
Single	$1000	$850	$1250	$1000
Double	$1750	$1500	$2250	$1750

Cancellations received prior to February 1, 2009, will receive a refund of fees paid less a $250 handling charge. Cancellations made after February 1, 2009, will forfeit the entire fee.

III. Sponsorship and Advertising

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

Sponsorship Levels (NEW THIS YEAR!)

Platinum ($2,500+)	$
Gold ($1,000)	$
Silver ($500)	$
Bronze ($250)	$

	Bronze	Silver	Gold	Platinum
Recognition in program guide/sponsor-higher levels/sponsorship recognized prominently	X	X	X	X
Option to include promotional material in conference tote bag	X	X	X	X
Recognition on projection screen in general sessions	X	X	X	X
Business Card black and white (color) ad in the program guide		X	X	X
Quarter page black and white (color) ad in the program guide			X	X
Signage at the registration/information desk and general session entrance			X	X
10% of sponsorship allocated to the TXHIMA scholarships			X	X
Recognition in the Convention Newsletter, Convention brochure/web page				X
Introduction of a Representative at first general session each day of Convention				X
Assigned Meeting Room (up to 2 hours) Invitation Only with Client/Customer/After Hours ONLY				X
	$250	$500	$1,000	$2,500+

Advertising in the Convention Program

Note: Ad deadline is March 16, 2009. Please submit ad to Cherry Kay Abel.

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

$175 half page $900 inside front

$150 quarter page $750 inside back

$80 business card $1000 outside back

$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.

V. Attendance

* Attendees:

How many company attendees will be present at the conference?
Two (2) badges are included in the booth fee.

Name Badges:

Please list the participants that will require name badges.

Name

VI. 2009 TxHIMA Corporate Membership

Corporate Membership

Yes, I would like to be a 2009 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 Hyatt Regency Dallas, Dallas Texas its owners or managers which results from any act of omission of Exhibitor. Exhibitor agrees to defend, indemnify and hold harmless, the Hyatt Regency Dallas, 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".

Payment options include: Credit card and check