South Dakota Dental Association May 17-18, 2012 Exhibitor Show
Use this form to register your company for a vendor booth. Please note that you must pay by credit card when using this form.   If you are a nonprofit organization please do not use this form. Contact Brenda at the Association office at (605) 224-9133 or at brenda@sddental.org.
Fields marked with * are mandatory
Company/Organization:*
Type of Exhibit:*
Address:*
City, State and Zip:*
Phone:*
Contact Person:*
E-mail addess:*
Does your booth need electricity?*
Companies you DO wish to be near:
Companies you do NOT wish to be near:
Please list the names of individuals staffing your booth(s). Only persons listed at the registration desk and wearing an SDDA name badge will be allowed in the exhibit hall.
On-site Main Contact Name:*	If this is the same person AND contact details entered above type SAME. Otherwise please enter the details for the on-site contact.
Mailing Address:
City, State and Zip:
Phone:
E-mail Address:
Second Staff Member Name:
Third Staff member:
Forth Staff member:
Fifth Staff member:
Sixth Staff member:
	IF you need to add more booth staff please scroll down to the bottom of the form.

EXHIBIT BOOTH SPACE
In the spaces below enter the quanity needed then click the Calculate Total Due button. You will be able to review your totals and all your details before you make payment.
Quantity	Item
	$550 for first booth ($650 after April 1, 2012)
	$450 for each addional booth
	$20 per extra table (1st table is complimentary)
	$50 for 1/2 page ad in Program Book
	$100 for full page ad in Program Book
	$400 morning coffee sponsor
	$900 afternoon break sponsor
	$2000 morning break sponsor
	$5000 exhibit hall lunch sponsor
	$7.5000 each for Thursday lunch ticket
	$7.5000 each for Friday lunch ticket
	$50 each for Friday night Mixer Dinner ticket
You can make updates and changes after you click the Calculate Total Due button.
$
Total Due
	Once you click this button you will be taken to the payment form. After you have paid you will be able to print out a confirmation form with all of this information.
Enter additional booth staff in the fields below. If you need more than 20 please contact the office.
7:
8:
9:
10:
11:
12:
13:
14:
15:
16:
17:
18:
19:
20:
		v1230a