American Psychiatric Nurses Association

25th Annual Conference

October 19-22, 2011 ▪ Anaheim, CA

Tote Bag Insert Application

APNA’s Tote Bag Insert

As psychiatric nurses register for the APNA conference, your company’s sales and promotional literature can be awaiting them in their registration packets, alerting them to your products and services and encouraging them to visit your booth. APNA is pleased to offer its exclusive 25th Annual Conference Tote Bag Insert to official conference exhibitors.

APNA will distribute your literature, promotional materials, sales brochures, etc. to all attendees as they register for the conference. The cost to participate in the Tote Bag Insert is $900 for one piece or $1,200 for two pieces.

Tote Bag Insert materials may be no larger than 8 ½” x 11”.

To reserve space in APNA’s Tote Bag Insert, please complete and return this contract, along with full payment, by September 30. 2011. Confirmation and shipping instructions will be provided. Please provide a sample to APNA for approval prior to shipping.

[ ] We would like to participate in the APNA 25th Annual Conference Tote Bag Insert

Number of items ______

1.  Enclosed is our payment for service in the form of a check or credit card, drawn on a U.S. bank, in U.S. funds,

made payable to “APNA.”. (Tax ID No. 22-2814679.)

Total prepayment required $______

2.  We understand that the deadline to commit to the APNA Tote Bag Insert is September 30, 2011.

Exhibiting Organization ______Booth # ______

Address ______

City ______State ______Zip Code ______

Phone ______Fax ______E-Mail ______

Signature ______Date ______

Payment Method - Check - Credit Card - Other (Please circle one) Payment Amount $______

Credit Card Information

______

Card Number Expiration Date (MM/YYYY)

______

Name As It Appears On Card

______

Billing Address (If Different Than Above)

Send completed application and payment, no later than September 30, 2011, to:

APNA Tote Bag Insert, Attn: Keely McNerney, 12708 Autumn Crest Drive, Oak Hill, VA 20171.

Shipping instructions will follow, please DO NOT ship to the address listed above, thank you!