EXHIBITOR REGISTRATION FORM
Philadelphia Marriott Downtown ǀ Philadelphia, PA
By Fax: 301.694.5124 By Mail/Check: PO Box 226125, Dallas, TX 75222-6125
Registration & Housing Customer Service Toll: 888.776.2976 Email: [email protected]
BOOTH INFORMATION (Please print legibly)
EXHIBITING COMPANY NAME
Each 10x10 booth space comes with one (1) complimentary Delegate Registration (Full Conference Access) and two (2) Booth Staff registrations (Access to Exhibition ONLY).
Exhibitor Delegate (Additional/Upgrade) registration may be purchased for a fee of $750 (Early Bird good thru January 31, 2015) / $1,000 (February 1, 2015 – Onsite).
No more than three (3) representatives from a company per 10x10 booth space are allowed in a booth at any given time. Exhibiting company must be current with its 2015 membership dues at the
time of PRSM2015 National Conference. Additional booth staff registrations are not available for PRSM Conference. You can purchase additional tickets for the amount listed on next page.
BOOTH PERSONNEL INFORMATION (Please print legibly)
EXHIBITOR DELEGATE registration includes admission to Exhibition, all meal functions (including Welcome Reception, Monday, April 27, and Awards & Sponsor Recognition
Luncheon, Tuesday, April 28), educations sessions (including General Sessions, Tuesday, April 28 & Wednesday, April 29).and conference materials.
BOOTH STAFF registration includes admission to Exhibition and Vendor Networking Breakfast (Tuesday, April 28). Tickets available for purchase to attend Welcome
Reception (Monday, April 27), Awards and Sponsor Recognition Luncheon (Tuesday, April 28), and Closing Event (Wednesday, April 29). Option to upgrade to Exhibitor
Delegate is also available.
GUEST/SPOUSE registration includes admission to Welcome Reception (Monday, April 27), Awards & Sponsor Recognition Luncheon (Tuesday, April 28), General Session
(Wednesday, April 29), and Closing Event (Wednesday, April 29).If an individual is not qualified as a guest/spouse, registration will be subject to cancellation.
GOLF CHALLENGE, CLUB RENTAL and STREET HOCKEY are not included in registration. Additional fees apply.
BOOTH PERSONNEL #1
 Exhibitor Delegate
Registration Type:
First Name
Last Name
 Booth Staff
Designation _______________
___
Title
___
Address
City
Phone
State
Zip
Email
________ ___
__
Guest/Spouse Name (if purchasing Guest/Spouse Registration) _______
___
___
CONSENT TO USE PHOTOS
Registration and attendance at, or participation in, PRSM conferences and other activities constitutes an agreement by the registrant to PRSM’s use and distribution (both
now and in the future) of the registrant or attendee’s image or voice in photographs, videotapes, electronic reproductions, and audio tapes of such events and activities.
CONFERENCE QUESTIONS (Must complete for processing)
1st PRSM Conference?  Yes  No
How did you hear about the PRSM2015 National Conference?
 Colleague
 Direct Mail
 Email
 Phone
Special dietary meals or have food allergies?
 Yes
 PRSM Website
Please provide Colleague’s name or Other:
 Other
______
Pls. specify:
 No/None
ADA: Pursuant to the Americans with Disabilities Act, I require specific aids for:  Audio  Visual  Mobile
BOOTH PERSONNEL #2
First Name
 None
Registration Type:
Last Name
 Exhibitor Delegate
 Booth Staff
Designation _______________
___
Title
___
Address
Phone
City
Email
Guest/Spouse Name (if purchasing Guest/Spouse Registration) _______
State
Zip
________ ___
__
___
___
CONSENT TO USE PHOTOS
Registration and attendance at, or participation in, PRSM conferences and other activities constitutes an agreement by the registrant to PRSM’s use and distribution (both
now and in the future) of the registrant or attendee’s image or voice in photographs, videotapes, electronic reproductions, and audio tapes of such events and activities.
CONFERENCE QUESTIONS (Must complete for processing)
1st PRSM Conference?  Yes  No
How did you hear about the PRSM2015 National Conference?
 Colleague
 Direct Mail
 Email
 Phone
Special dietary meals or have food allergies?
 Yes
 PRSM Website
Please provide Colleague’s name or Other:
 Other
______
Pls. specify:
 No/None
ADA: Pursuant to the Americans with Disabilities Act, I require specific aids for:  Audio  Visual  Mobile
BOOTH PERSONNEL #3
 None
 Exhibitor Delegate
Registration Type:
First Name
Last Name
 Booth Staff
Designation _______________
___
Title
___
Address
City
Phone
State
Zip
Email
________ ___
__
Guest/Spouse Name (if purchasing Guest/Spouse Registration) _______
___
___
CONSENT TO USE PHOTOS
Registration and attendance at, or participation in, PRSM conferences and other activities constitutes an agreement by the registrant to PRSM’s use and distribution (both
now and in the future) of the registrant or attendee’s image or voice in photographs, videotapes, electronic reproductions, and audio tapes of such events and activities.
CONFERENCE QUESTIONS (Must complete for processing)
1st PRSM Conference?  Yes  No
How did you hear about the PRSM2015 National Conference?
 Colleague
 Direct Mail
 Email
 Phone
 PRSM Website
Please provide Colleague’s name or Other:
Special dietary meals or have food allergies?
 Yes
 Other
______
Pls. specify:
 No/None
ADA: Pursuant to the Americans with Disabilities Act, I require specific aids for:  Audio  Visual  Mobile
REGISTRATION FEE
 None
Registration (Cancellation) Cut-off: Friday, April 10, 2015
REGISTRATION CATEGORY
Exhibitor Delegate Registration (Additional/Upgrade)
EARLY BIRD FEE
Thru 1/31/15
$750
REGULAR FEE
2/1/15 - Onsite
$1,000
AMOUNT
$
ADDITIONAL TICKETS
Guest/Spouse Registration
(Please provide name above under corresponding Booth Personnel)
Golf Challenge (Monday, April 27)
|
Club Rental
$
$275
$255 (Green Fee) |
$95 (Rental)
$
Player 1: _______________________________  Mens  Womens |  Left-hand  Right-hand
Player 2: _______________________________  Mens  Womens |  Left-hand  Right-hand
Player 3:: ______________________________  Mens  Womens |  Left-hand  Right-hand
By selecting to rent clubs, you agree to return the rental clubs and accessories in the same condition in which
they were received and to be responsible for any damages or losses incurred while clubs are in my
possession
Street Hockey (Monday, April 27)
$25
$
Welcome Reception (Monday, April 27)
$125
$
Awards & Sponsor Recognition Luncheon (Tuesday, April 28)
$55
$
$125
$
Closing Event – Booth Staff Only (Wednesday, April 29)
HOUSING INFORMATION
Housing Cut-off: Friday, April 10, 2015
 Philadelphia Marriott Downtown (HOST HOTEL) ǀ $199 night + tax
 Courtyard Philadelphia Downtown ǀ $189 night + tax
 As credit card is required to guarantee hotel reservations, I authorize to use the same credit card listed below.
1)
Name on Reservation
Room Type: � King
Arrival Date
� Double/Double
Name of person(s) sharing room
2) Name on Reservation
Room Type: � King
_
Arrival Date
� Double/Double
Name of person(s) sharing room
� Double/Double
Name of person(s) sharing room
3) Name on Reservation
Room Type: � King
__
Departure Date
__________
Special requests
__________
Departure Date
__________
__
_
Special requests
__________
Departure Date
__________
__
_
Special requests
__________
Arrival Date
PAYMENT INFORMATION


 Check
Payable to: PRSM Association
Total Amount Due
Credit Card
 AmEx
 Diner
 MasterCard
 VISA
Date
Credit Card #
Expiration Date (5/2015 or after)
Security Code
Name as it appears on Card
Billing Address
Cardholder’s Signature (Registration not valid without signature and payment)
REGISTRATION/HOUSING POLICIES:
 Payment: Registrations will not be processed without FULL PAYMENT for Exhibit Booth, Exhibitor Delegate (Additional/Upgrade) registrations or additional tickets.
Payment must be made by major credit card, check in US dollars only. Mail check payments to: PRSM Association, PO Box 226125, Dallas, TX 75222-6125. Payment
(for registration) by credit card, please send by fax at 301.694.5124. If making payment for Exhibit Booth by credit card, please send by fax at 972.231.4081.
 Membership: Exhibiting Companies must be current 2015 PRSM Association members to exhibit. If you are not a member and would like to join PRSM Association,
please complete the Allied Corporate (Supplier) Membership Application. Once complete, applications to exhibit at the PRSM2015 National Conference will be
processed.
 Supplier Orientation: At least one (1) registered attendee is required to attend the Supplier Orientation.
 Exhibitor Delegate Registration includes admission to Exhibition, all meal functions (including Welcome Reception, Monday, April 27, Supplier Networking Breakfast,
and Awards & Sponsor Recognition Luncheon, Tuesday, April 28, and Closing Event, Wednesday, April 29), educations sessions (including General Session, Tuesday,
April 28).and conference materials.
 Booth Staff Registration includes admission to Exhibition, Supplier Networking Breakfast and Opening General Session (Tuesday, April 28). Tickets available for
purchase to attend Welcome Reception (Monday, April 27), Awards and Sponsor Recognition Luncheon (Tuesday, April 28), and Closing Event (Wednesday, April 29).
Option to upgrade to Exhibitor Delegate is also available.
 Guest/Spouse Registration includes admission to Welcome Reception (Monday, April 27), Opening General Session and Awards and Sponsor Recognition Luncheon
(Tuesday, April 28), and Closing Event (Wednesday, April 29).If an individual is not qualified as a guest/spouse registration will be subject to cancellation.
 Golf Challenge, Club Rental and Street Hockey have separate registration fees and are available for purchase by registered full conference attendees.
 Lost/Stolen Badges: Lost or stolen badges are subject to a $100 replacement fee. Badge replacement fee is non-refundable.
 Exhibit Booth Cancellation: Please refer to Exhibitor Contract. You may contact the Vendor Relations Department by email at [email protected] or at 972.231.9810.
 Registration Cancellations: All registration cancellations must be received in writing by email at [email protected]. Prior to April 10, 2015: Cancellations
received will receive a full refund minus a $100 cancellation fee. After April 10: No refunds. For further assistance, you may contact Conference Registration & Housing
Customer Service at 888.776.2976.
 Housing Cancellations: Reservation cancellations made after March 16, will incur a charge of one night's room rate charged to the credit card used for guarantee
regardless of when the initial room request was received. PRSM customer service will accept in writing, by email to [email protected], requests for
reservation changes and cancellations until 5pm (ET), April 10. Beginning April 16 and prior to 72 hours of your date of arrival, please contact your hotel directly for
changes or cancellations. Reservations canceled within 72 hours of arrival or failure to arrive on scheduled date of arrival is subject to a cancellation fee equal to one
night’s room rate plus tax. In addition, hotel may charge an early departure fee for checking out earlier than scheduled. To avoid this, please verify your departure date
prior to or upon arrival.
 Substitutions: All requests for REGISTRATION substitutions must be made in writing with a completed registration form faxed to 301.694.5124 by 5pm ET, April 20,
2015. Additional fees may be required based on the replacement’s membership status. After April 20, late REGISTRATION substitutions will be processed onsite.