Request the Exhibit — Self-Determined

SELF DETERMINED EXHIBIT REQUEST FORM

Thank you for your interest in the Self-Determined Exhibit. Please complete the following form to request the exhibit. Submission of this form does not guarantee placement. Our team will review your request and follow up with further details.

CONTACT INFORMATION

Organization/Company Name

Contact Person

First Name

Last Name

Title/Position

Email

Phone

(###)

###

####

EXHIBIT DATES & PREFERENCES

Start Date

MM

DD

YYYY

End Date

MM

DD

YYYY

Event Location and Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Expected Audience

On-site Contact

Load in/Load Out Times:

EXHIBITING SPACE SPECIFICS

Available Square Footage

Message

Access to Power:

YES

NO

Access to Internet:

YES

NO

Is the venue secured overnight?

YES

NO

Will a staff member or volunteer be on-site during the exhibition?

YES

NO

ADDITIONAL INFORMATION

Is your organization willing to cover, in part or in whole, the costs of shipping and staffing the exhibit?

(Provide any additional information you wish to include.)