Exhibitor Commitment Form 2009

   Case Management: Thinking" Outside the Box"
     Ritz Charles
      12156 N. Meridian Street
      Carmel, IN 46032
   October 15, 2009
EXHIBITOR COMMITMENT FORM

Company Name: _____________________________________________________________________________

Address: ___________________________________________________________________________________

City: __________________________________________________ State: _________ Zip: __________________

Contact Person: _____________________________________________________ Title: ____________________

Phone: ___________________________________________________Fax: ______________________________

Email: ______________________________________________________________________________________

Exhibit Representative(s)

Name: __________________________________Phone: ________________

Mail to:
CICMSA
Attn: Gina Foster
9615 N. College Avenue
Indianapolis, IN 46280

ADDITIONAL EXHIBITOR(S) for LUNCH $40.00 each

Name: __________________________________Phone: ________________

SPONSORS/EXHIBITORS/SUPPORTER

Please indicate the level at which you would like to participate.

____Title Sponsor/Exhibitor, $2000.00 ____Silver Sponsor/Exhibitor, $450.00

____Platinum Sponsor/Exhibitor, $750.00 ____Session Supporter, $300.00

____Gold Sponsor/Exhibitor, $600.00
Make Checks payable to CICMSA Total $ ____________

Please indicate if you need electricity. Yes ____ Please bring an extension cord. There may be an additional charge for facility exhibit services from the Ritz Charles the day of the conference.
Please indicate if you desire to donate a door prize to be awarded periodically throughout the day.
The attendee who wins will report to your exhibit to claim their prize. Yes ______
Registration form and payment received by July 15, 2009 will reserve your exhibit space, listing in the
Registration Brochure and Attendee/Exhibitor/Sponsor Conference Booklet
Registration form and payment received by August 17, 2009 will reserve your exhibit space and listing in the Attendee/Exhibitor/Sponsor Conference Booklet.