TLPCA Counseling and Therapy Summit Exhibitor Registration & Other Options "*" indicates required fields Δ CommentsThis field is for validation purposes and should be left unchanged.Exhibitor Registration ItemsName 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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Business/Organization Website* Provide a business/organization description for the conference program.*File or Graphic for promotional purposes:* Drop files here or Select files Accepted file types: jpg, png, 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 ParticipationExhibitor Options* Exhibit Table (with two (2) Summit registrations) - $700 Exhibit Table (with one (1) Summit registration) - $500 Exhibit Table (without Summit registration) - $350 None of the above Additional Options* Bag Inserts $400 Full page ad in program book $300 Half page ad in program book $200 Quarter page ad in program book $150 None of the above Contact the conference coordinator at executivedirector@tlpca.net to make arrangements for your promotional item.Complimentary RegistrationsPlease provide the names of ALL of the complimentary conference attendees below, including yourself.Name of Person 1 to receive complimentary registration* First Last Email of Person 1 to receive complimentary registration* Enter Email Confirm Email Name of Person 2 to receive complimentary registration* First Last Email of Person 2 to receive complimentary registration* Enter Email Confirm Email Payment InformationTotal Coupon Payment Option* Check Credit Card Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Annual ConferenceCall for Proposals Registration & Payment General Info Location 2026 Pre-Conferences CE Information Sponsors & Exhibitors Opportunities Sponsor Registration Exhibitor Registration & Other Options 2026 Summit Exhibitors 2026 Summit Sponsors Student Volunteers