Corporate Friends Sponsorship

CLICK HERE TO COMPLETE THE ONLINE FORM

CLICK ON THE IMAGE BELOW TO DOWNLOAD THE FORM

EXHIBITOR TYPE

Non-Profit ........................................ $200.00

Table in Vendor Exhibition area, with up to 2 people per table.
Access to the conference for 2 individuals with complimentary meals.
Listed as a vendor on BIALA website.

*There is a flat fee for those seeking CEUs: $50 per person.

Non-Profit ............................................. $350.00

6 ft. table in Exhibit Hall with 2 chairs
Access to the conference for same 2 individuals with complimentary meals and CEUs
Listed as an exhibitor in conference program and on BIALA website
Included in BIALA's online resource guide

Corporation ............................................. $500.00

6 ft. table in Exhibit Hall with 2 chairs
Access to the conference for same 2 individuals with complimentary meals and CEUs
Listed as an exhibitor in conference program and on BIALA website
Included in BIALA's online resource guide

*There is a flat fee for those seeking CEUs: $50 per person.

General Contact Information

Company/Organization Name *

Name of FIRST Representative*

Email Address *

Phone Number *

Seeking CEUs? *

Yes

No

If Yes, list discipline:

Joining Us For Lunch? *

Yes

No

If Yes, list dietary restrictions:

Name of SECOND Representative*

Email Address *

Phone Number *

Seeking CEUs? *

Yes

No

If Yes, list discipline:

Joining Us For Lunch? *

Yes

No

If Yes, list dietary restrictions:

Business Mailing Address

City *

State *

Zipcode/Postcode *

Will You Require Electrical Setup? *

Yes

No

If Yes, please submit $20 electrical set up fee.

Is your organization willing to donate a small door prize (i.e. $25 gift certificate, goodies basket, etc.) *

Yes

No

Authorization for Photo,Video, or Audio Recording of Presentation:
I grant permission to BIALA, itsrepresentatives, employees and volunteers the right to take photographs, videoand/or audio recordings in connection with any educational presentation, andauthorize BIALA, its assigns and transferees the right to use or publish samein print or electronically.My name and date entered below is myapproval for BIALA to use photographs/video/audio recordings of me (with orwithout my name) for any lawful purpose, including education, publicity,illustration, advertising, and web content.

Please fill out our exhibitor form above, or click the button to download a paper copy.

DOWNLOAD OUR EXHIBITOR APPLICATION

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First of all, thank you! Thank you for the magnificent website you have developed! I found some great information to help me with my fight against my own TBI. Resources just around the corner from where I lived that none of my doctors have referred me to are now at my fingertips. I continue to struggle and now am inspired to fight for others. I can't thank you enough for the work you have done.

Nicole Broussard

Individual with TBI

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My son sustained a spinal cord injury a few years ago, and I still rely on the resources BIALA has to offer to help us live our lives. When I am feeling down and need some encouragement, the BIALA hotline is the first place I reach out to. I feel a sense of relief after I call because of the kindness and compassion I am given. BIALA seems to really care about those they serve, and I am so thankful to have someone to talk to.

Berly Rose

Caregiver

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When I called the helpline, I was so happy to learn about the trust fund I could apply for. I had no clue about it but am glad I know now because living with a brain injury is expensive and hard. The lady I spoke with was so nice, took the time to answer all my questions, and made me laugh. She gave me some hope and that is pretty cool.

Harry Thomas