Exhibitor Application

20th Annual Wisconsin Council on
Problem Gambling Conference
March 14-15, 2019 
Blue Harbor Resort in Sheboygan, WI

EXHIBIT SPACE APPLICATION AND CONTRACT

NAME OF ORGANIZATION:__________________________________________________________________________________

 

ADDRESS:_______________________________________________________________________________________

 

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, listed below (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 13th. 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 13, 2019, 9am-4:30pm) workshops?

$ 50.00      "Trauma-Informed Care: Putting Humanity Back into Human Services" - Scott Webb

$ 50.00      "Gambling Supervision" - Jerry Bauerkemper

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

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

AWARDS BANQUET: Thursday, March 14, 2019, 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

_______________________________________________________________________________________________________

Title/Position

ALL EXHIBIT APPLICATIONS MUST BE RECEIVED BY February 20, 2019

Mail application and payment to:

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