Mountain Air Symposium – Vendor Registration Mountain Air Symposium Vendor / Sponsorship 1 Registrant Information2 Payment Information Contact InformationCompany Name* Company Contact Person* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Enter Email Confirm Email Please provide a method to contact you in the event of special conference announcements. A registration confirmation email will be sent. Duplicate email addresses are not accepted.PhoneCompany InformationList items your company sellsList up to two company representatives attending. An additional representative may register on the payment page.Representative First Last Credentials AARC NumberIf your representative is an AARC member and is requesting CRCE credit, please provide their AARC membership number.Representative First Last Credentials AARC NumberIf your representative is an AARC member and is requesting CRCE credit, please provide their AARC membership number. Exhibit InformationFee is $150 for a 15 minute spotlight from your company, you may present live to attendees via our Webex format or you can send a pre-recorded powerpoint to Symposium chair person and we will play that during your spotlight between speakers. Rules and Regulations*Security and Liabilities: Exhibitors are encouraged to take precautions to protect their own property and to arrange for appropriate insurance against loss. The VSRC nor Roanoke Higher Education Center can assume responsibility for the loss of, or damage to, exhibitors’ property. The exhibitor agrees that the Virginia Society for Respiratory Care, Roanoke Higher Education Cente,r its agents, and its employees: (A) will not be responsible for any damage to or for the loss or destruction of the exhibitor’s property or injuries to the exhibitor, his representatives, agents or employees: all claims for any such loss, damage, destruction, or injury being expressly waived by the exhibitor; (B) Will be exempted from or indemnified for any claims for injury to any exhibitor’s representatives or employees. The Virginia Society for Respiratory Care, Roanoke Higher Education Center, its agents, and its employees will not be liable for failure to hold the exhibit as scheduled. Payments for booth space and other paid fees will be returned in that event except that no expenses incurred relating to the exhibit will be deducted if the exhibit is cancelled because of fires or any act of God, or public enemy, or strike, or epidemic, or any law or regulations of public authority, which makes it impossible or impractical to hold the conference or exhibits. Registration and Payment: Registration must be made via www.vsrc.org and payment is expected prior to the date of the conference. Payments by check may be mailed to: Wendy Ayers, VSRC Treasurer, 18 Fairfax Cir, Madison Heights, VA 24572-2806. Tax ID# is available upon request. Cancellation Policy: It is policy of the VSRC that all cancellations must be submitted in writing, 7 calendar days before the scheduled event (November 5, 2018) to be eligible for a registration fee refund. The VSRC Executive Board of Directors will review emergency cancellations and refund eligibility will be decided on a case-by-case basis. In the event of a cancellation by the exhibitor, the VSRC has the right to retain booth fees if a cancellation is received less than 7 calendar days prior to the scheduled event. The VSRC also has the right to rent the vacated space to another vendor once a cancellation is confirmed. Admissions: The VSRC will have sole control over all admissions of persons. All persons visiting the exhibit area will be admitted according to the rules and regulations of the exhibit as issued or amended by the authorized representatives for the VSRC. Objectionable Material and Activities: Authorized representatives of the VSRC reserve the right to request modification of any questionable exhibit. Flammable substances are subject to local fire code. It is the responsibility of each company to appropriately transport booth equipment at its own expense. Continuing Respiratory Care Education (CRCE) Credit: Vendor representatives who are registered as an exhibitor may receive CRCE credit for no additional fees with completed attendance log and evaluation forms. Agreement: By purchasing this booth, the exhibitor agrees to abide by these rules and regulations and the decisions of the VSRC. Failure to abide by these rules may result in expulsion from the planned event. For additional information contact: Shari Toomey, MBA, RRT-NPS, firstname.lastname@example.org (540)263-2155 I agree to the Rules and Regulations Vendor Spotlight*Day1 #1Day1 #2Day2 #1Day2 #2TBDTBDTotal $0.00 Payment choice*Credit / Debit CardCheckCredit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.