Partner Application and Contract for Exhibit Space DIA 2017 Annual Conference The Royal Sonesta New Orleans, LA Meeting Dates April 19-22, 2017 (Setup afternoon of April 19) Please fill out the application below: Exhibiting Company Name*Logistical Contact Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email* Service/Products to be exhibitedPartner Package*Platinum Partner $4,500Gold Partner $3,000Silver Partner $1,500 (Exhibit only)Annual Conference AttendeesAttendee Name (included in package)Attendee Name (included in package)Do you have Additional Attendees?*YesNoCost Per Additional Attendee Price: $250.00 Number Additional AttendeesAdditional Attendees NamesPayment InformationCart Total $0.00 This page is unsecured. Do not enter a real credit card number! Use this field only for testing purposes. Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name Packages Include: Each Table-Top exhibit space in the exhibit hall/dining room includes: 1) A 6ft draped table with chairs for your company display 2) Scheduled Presentation time (Platinum and Gold) 3) Invitation to the Welcome Reception and Dinner 4) VIP networking opportunity at Connections & Cocktails 5) VIP networking event at the Partner Recognition Cocktail Reception 6) Specified Partner Time will be listed on the Agenda – in addition to breaks and meals 7) Prominent promotion on the DIA website and all Conference materials and access to the new FaceBook Private DIA Page for the entire year! This page allows all of our Partners access to our members for the entire year, in a venue which allows for Q&A, product/service debuts and discussions and blogs. Cancellation and Downsizing Policy -Cancellation / Downsizing fees are based on the total amount and will be deducted from payment received. -Cancellation / Downsizing fees are not transferable. -Cancellation / Downsizing requests MUST be in writing and may be emailed to firstname.lastname@example.org. Cancellation / Downsizing fees will be withheld as follows: -Notifications received on or before October 5, 2016 = 0% Withheld -Notifications received October 6, 2016 – December 13, 2016 = 25% Withheld -Notifications received December 14, 2016 – February 21, 2017 = 50% Withheld -Notifications received after February 22, 2017 = NO REFUND CommentsThis field is for validation purposes and should be left unchanged.