WEST TEXAS A&M UNIVERSITY and REGION 16 EDUCATION SERVICE CENTER

PANHANDLE MATH AND SCIENCE CONFERENCE EXHIBITOR REQUEST FORM

July 25 - 26, 2017

Contact Person ______

Name of Organization ______

Address ______

Phone ______E-Mail Address ______

Please mark the appropriate selection(s) below:

_____Our Organization will provide an exhibit at the Conference on July 25th and 26th.

_____We will provide speaker(s) for Conference sessions. A Speaker Proposal Form will be posted at www.wtamu.edu/pmsc.

_____We will bring door prizes for participants

If you plan to provide an exhibit, please complete the following information:

# of tables / # of chairs / Sponsorship Level
Platinum level sponsor ($500): FaceTime at lunch to speak about your product/services, Priority placement for up to four exhibitor tables, Large icon on poster, Full Page PowerPoint slide during lunch both days, up to two lunch tickets each day.
Gold level sponsor ($300): Quick company introduction at lunch, Up to three exhibitor tables, Medium size icon on poster, Half Page PowerPoint slide during lunch both days, up to two lunch tickets each day.
Silver level sponsor ($200): Up to two exhibitor tables, Small size icon on poster, Listed on PowerPoint slide, up to two lunch tickets each day.
Bronze level sponsor ($100): One exhibitor table, up to two lunch tickets for each day.
Exhibitor only ($40): One exhibitor table (Does not include lunch tickets but may purchase below.)
Non-Profit Organization: No charge for one exhibitor table (Does not include lunch tickets but may purchase below.)

We would like to purchase ______lunch tickets at the cost of $20/two day ticket.

Do you need electrical outlets for your exhibit? YES NO (Extension Cords WILL NOT be provided.)

Other space requests?______

TOTAL AMOUNT OF CHECK ENCLOSED: $______

(Please make checks payable to WTAMU PMSC EXHIBIT.)
Please return this form and appropriate fees no later than June 30th, 2017, to:

Department of Chemistry & Physics; WTAMU Box 60732; Canyon, TX 79016

Please email a digital version of your Logo to Cathy Clewett, below.

For questions contact: Dr. Cathy Clewett email: phone: 806-651-2545

Dr. Carolyn Bouma email: phone: 806-651-2569

Dr. Kristina Gill email: phone: 806-651-2538

NOTE: Your Form is not “RECEIVED” (or your space assigned) until required fees are paid.