TLPCA Counseling and Therapy Summit

Exhibitor Registration

2023 Exhibit and Sponsor Prospectus

"*" indicates required fields

Exhibitor Registration Items

Name of Organization (as it will appear in the conference program):*

Name of Contact Person to Receive All Exhibit Information:*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Business/Organization Website*

Complimentary Registrations

Please provide the names of the complimentary conference attendees below. Refer to the exhibitor and/or sponsorship packet information for the number of complimentary registrations. If your sponsorship allows for more than one complementary registration, click on the plus button next to the first name to add more.

Name of persons to receive complimentary registration

Name

Provide a business/organization description for the conference program.

File or Graphic for promotional purposes:

Drop files here or

Max. file size: 29 MB, Max. files: 3.

DISCLAIMER*

I agree.

TLPCA does not provide a list of registrants or attendee contact information as part of any exhibit or sponsorship packages.

Levels of Support and Participation

Exhibitor Options*

Exhibit Table (with two (2) Summit registrations) - $600

Exhibit Table (with one (1) Summit registration) - $400

Exhibit Table (without Summit registration) - $300

Total

Payment Option*

Check

Credit Card

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Billing Address*

Street Address Address Line 2 City State ZIP Code

Name

This field is for validation purposes and should be left unchanged.

TLPCA Counseling and Therapy Summit

Exhibitor Registration

Exhibitor Registration Items

Complimentary Registrations

Levels of Support and Participation

Annual Conference

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