Exhibitor Application

18th Annual Wisconsin Council on Problem Gambling Conference

March 23-24, 2017, the Osthoff Resort in Elkhart Lake, WI



NAME OF ORGANIZATION:__________________________________________________________________________________


CITY:__________________________________STATE:______________ ZIP____________________

PERSON(S) RESPONSIBLE FOR EXHIBIT:_______________________________________________

ADDRESS, IF DIFFERENT FROM ABOVE:________________________________________________

CITY_____________________________________STATE:___________ ZIP: ___________________

TELEPHONE: (____)____________________________ FAX: (____)__________________________

E-MAIL: _______________________________________________­___________________________

EXHIBIT SPACE: The cost per table is $175.00. This includes one 8' table and registration for one person to accompany your booth and participate in conference workshops and meals during the conference.  Pre-conference workshops are an additional cost, lunch is not included.  Additional persons can attend by completing the registration form found on the conference brochure and paying the applicable conference rate.  If the additional person(s) would like meals only it would be an additional $50.00.  Space is limited; only 15 exhibitor spaces are available.  You will be able to set up any time after 6:00pm on Wednesday, March 22nd. Join or renew your WCPG membership and save $35.00 off the Full Conference Registration (Discount for Memberships of $75 or more).

` $ 50.00              Pre-Conference (March 22, 2017 9am-4:30pm)
"Leadership 2.0: An Advanced Workshop for Supervisors in the Behavioral Health Field" - Mark Sanders

` $ 80.00              Motivational Interviewing Track With Full Conference (March 22-24, 2017)
"Motivational Interviewing"- Scott Caldwell


Electricity needed?  No_______ Yes_______             Number of Tables: ______________

Payment enclosed:________________.  Make checks payable to the WISCONSIN COUNCIL ON PROBLEM GAMBLING (WCPG).  Payment must accompany application.

Please check if you plan to attend: (included in Exhibit fee)

ETHICS: □   (you MUST check the box to participate in the workshop)


AWARDS BANQUET: Thursday, March 23, 2017, 6:00pm-9:00pm. □ I will be attending                                                                                                                                                    □ I will not be attending

MEALS: □ Regular      □ Vegetarian

□ I do not authorize the WCPG to publish my address                    □ Yes, I need EAP - Continuing Education

The Wisconsin Council on Problem Gambling, Inc. assumes no liability for damage to exhibits, either in transit to or from the hotel or while the exhibit is in the hotel.  The exhibitor assumes all liability for the exhibit.

The Council reserves the right to determine the eligibility of all exhibit space and individual products and services to be exhibited. Exhibits which are determined to be inconsistent with the high standards of the Conference or are otherwise noisy, in bad taste, or conflict with the orderly management of the Conference, will be denied admission to the conference.


Signature of Applicant                                                                                               Date




Mail application and payment to:

Wisconsin Council on Problem Gambling, Inc.
Attn: Conference Coordinator
1585 Allouez Ave.
Green Bay, WI  54311