Exhibitor Application

19th Annual Wisconsin Council on Problem Gambling Conference

March 15-16, 2018, the Milwaukee Marriott West in Waukesha, 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 14th. Join or renew your WCPG membership and save $35.00 off the Full Conference Registration (Discount for Memberships of $75 or more).

Do you plan to attend Pre-Conference (March 14, 2018, 9am-4:30pm) workshops?

$ 50.00   "Clinical Supervision and Professional Development: A Practical and Effective Approach" - Jim Harrison

$ 50.00  "Addiction and Finances: Understanding the Need for Financial Recovery" - Jerry Bauerkemper

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 15, 2018, 6:00pm-9:00pm. □ I will be attending                                                                                                                                            □ I will not be attending

MEALS: □ Regular      □ Vegetarian

Electricity needed?  No_______ Yes_______             Number of Tables: ______________

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

□ 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