1. Healthcare

2015 Annual Conference • April 15-17, 2015
Tan-Tar-A Resort • Osage Beach, Missouri
SPONSORSHIP APPLICATION AND REGISTRATION FORM
To reserve your space and be a conference sponsor, complete the application and return by January 30, 2015.
The 2014 sponsors receive first priority for display space until January 8, 2015. Sponsorship application is not
complete until payment has been received and you receive a confirmation email.
Company Name ___________________________________________________________________________________
Address __________________________________________________________________________________________
City, State, Zip _____________________________________________________________________________________
Phone __________________________ Fax _________________________ Email _____________________________
Contact Signature _________________________________________________________________________________
❑ SILVER ($600)
❑ GOLD ($1,200)
❑ PLATINUM ($2,000)
• Brochure Acknowledgement:
Company Name Only
• Email Acknowledgement
• Event/Session Recognition
• Sponsor Ribbons
• Attendee List:
Post-conference Copy
• One Conference Registration
• Brochure Acknowledgement:
Company Logo
• Email Acknowledgement
• Event/Session Recognition
• Sponsor Ribbons
• Attendee List: Advance Copy
• One Conference Registration
and Golf Outing
• Brochure Acknowledgement:
Company Logo
• Email Acknowledgement
• Event/Session Recognition
• Sponsor Ribbons
• Attendee List: Advance Copy
• Two Conference
Registrations and Golf Outings
DISPLAY BOOTH ( There are 30 display spaces available for sponsors only)
❑ Yes, I would like a display booth. The display booth fee is $50. ❑ No, I do not need a display booth.
2015 EXHIBIT SCHEDULE
Wednesday, April 15, 2015
3:00 p.m. – 9:00 p.m. Move-in/Set-up
Thursday, April 16, 2015
7:00 a.m. – 3:00 p.m. Sponsor Hall Open*
3:00 p.m. – 5:00 p.m. Dismantle
*Sponsor Hall Special Event: Door-prize drawings will be held mid-afternoon.
Display Booth Fee of $50 Includes:
One six-foot skirted table, two chairs and one wastebasket. (Please note that display areas may include a tabletop
display and/or banner only. The area cannot accommodate extensive or elaborate displays.)
Amenities/Shipping and Drayage:
Tan-Tar-A will provide shipping and drayage as well as additional amenities (tables, chairs, electricity, internet,
etc.) for your company’s display. These forms are posted on the Missouri and Kansas Chapter websites.
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SPONSOR SUPPORT PREFERENCES
❑ Golf Trophies
❑ Registrant Gift
❑ Lunch(es)
❑ Golf Expenses
❑ Audiovisual
❑ Opening Reception
❑ Social Activity
❑ Printing
❑ Breakfast(s)
❑ Other _________________
❑ No Preference
2015 SPONSOR TERMS AND CONDITIONS
• The sponsoring organization will not be recognized in any promotional materials until this application is
signed and returned with payment. Payment must be received prior to the conference. A confirmation email
will be sent to the email address listed on Page 1.
• The 2014 sponsors will be given first priority with regard to the 2015 display space until January 8, 2015.
Spaces will then be assigned on a first-come, first-served basis.
• All sponsorship cancellations must be received by February 13, 2015. A refund of sponsor fees, less a $50
administration fee, will be given for written cancellation requests received by that date. No refunds will be
given for any cancellations received after February 13.
SPONSOR REGISTRATION INFORMATION
Each representative from your company/organization must register for the conference. Each additional
representative beyond sponsor-level benefits must complete and submit a Sponsor Additional Participant
Registration form with applicable fees. All golf participants must be registered for the entire conference.
Platinum Sponsor Conference Registration Name ______________________________________________________
Address (if different from page one) _________________________________________________________________
City, State, Zip _____________________________________________________________________________________
Phone ________________________________________ Email ____________________________________________
Platinum Sponsor Conference Registration Name ______________________________________________________
Address (if different from page one) _________________________________________________________________
City, State, Zip _____________________________________________________________________________________
Phone ________________________________________ Email ____________________________________________
Platinum Sponsor Golf Name __________________________________________________________________________
Address (if different from page one) ______________________________________________________________________
City, State, Zip ______________________________________________________________________________________
Phone ________________________________________ Email ______________________________________________
Platinum Sponsor Golf Name __________________________________________________________________________
Address (if different from page one) ______________________________________________________________________
City, State, Zip ______________________________________________________________________________________
Phone ________________________________________ Email ______________________________________________
Gold Sponsor Conference Registration Name _________________________________________________________
Address (if different from page one) _________________________________________________________________
City, State, Zip _____________________________________________________________________________________
Phone ________________________________________ Email ____________________________________________
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Gold Sponsor Golf Name _____________________________________________________________________________
Address (if different from page one) ______________________________________________________________________
City, State, Zip ______________________________________________________________________________________
Phone ________________________________________ Email ______________________________________________
Silver Sponsor Conference Registration Name _________________________________________________________
Address (if different from page one) _________________________________________________________________
City, State, Zip _____________________________________________________________________________________
Phone ________________________________________ Email ____________________________________________
Each additional representative from your company/organization must complete a Sponsor Additional
Participant Registration Form, available at www.moprima.org or www.kansasprima.org.
SPONSOR FEES
Sponsor Fees Due
Silver: $600
$
Gold: $1,200
$
Platinum: $2,000
$
Silver Golf Add-on Fee: $25
$
Display Booth Fee (if desired): $50
$
TOTAL AMOUNT DUE
$
Application/Registration Form and payment due by January 30, 2015.
LODGING INFORMATION
Lodging is available for attendees and sponsors at Tan-Tar-A Resort, Osage Beach, Missouri, at a discounted
rate of $99 per night, plus applicable taxes. This rate will be honored two days before and after the conference.
Cutoff date for reservations is March 17, 2015, based upon availability. Call 800-826-8272 to make your
reservation, or you may reserve your room online at www.tan-tar-a.com. The Group Reservation Code RIMA.
This sponsorship application and registration form is a fillable form. Save the form to your desktop,
complete the form electronically and email it as an attachment to: [email protected].
Or you may print the completed form and mail it with your payment to: MO/KS PRIMA Annual
Conference, c/o Custom Meeting Planners, P.O. Box 30785, Columbia, MO 65205.
For your convenience, a credit card may be used to pay for your sponsorship. Please note a 5 percent
merchant processing fees applies. Contact Tammy Bagley at [email protected] or by
phone at 573-881-4849 to pay by credit card.
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