2012 Public Law National Conference

Transcription

1 2012 Public Law National Conference Grand Traverse Resort and Spa 100 Grand Traverse Village Boulevard, Acme, MI Important Due Dates Registration includes complimentary shuttle service to and from Cherry Capital Airport (TVC) Early Bird Registration...November 25, 2011 Program Advertisement...January 20, 2012 Pre-Registration...January 28, 2012 REMINDER: Please make your hotel reservations by February 10, 2012 to receive special conference lodging rate. - $77.00* + tax/tourism -*Prevailing Federal Per Diem Rate For lodging reservations, call (800) Group Name: PL Lodging Reservations... February 10, 2012 For information, contact: Teresa Marie Willson - teresaw@cimcinc.com or Carol Jennings - carolj@cimcinc.com Phone: (916) Fax (916)

2 CONFERENCE REGISTRATION Tribe or Organization: Contact Person: Phone: FAX: 1.Registrant Name: 2. Registrant Name: 3. Registrant Name: 4. Registrant Name: 5. Registrant Name: CONFERENCE REGISTRATION FEE: Payments must be postmarked by required date to receive lower rates.no refunds are available. Registration includes complimentary shuttle service to and from Cherry Capital Airport (TVC). Early-Bird Registration (on or before November 25, 2011). $ Pre-Registration (by January 28, 2012)... $ Registration/On-Site Registration (after January 28, 2012) $ PAYMENT: ENCLOSED PAYMENT IS FOR A TOTAL OF INDIVIDUAL(S) X $ = $ Check # Purchase Order # Please charge following credit card (VISA/MasterCard Only): Card No.: Exp. Cardholder s Name (as it appears on card): Cardholder s Signature: REMINDER: Please make your hotel reservations by February 10, 2012 to receive special conference lodging rate. - $77.00* + tax/tourism *Prevailing Federal Per Diem Rate For reservations, call (800) Group Name: PL Make conference registration fee payable to: California Indian Manpower Consortium, Inc. Mail this completed form with payment to: California Indian Manpower Consortium, Inc. 738 North Market Boulevard Sacramento, California If paying by credit card, fax to (916) For Registration Information, contact: Teresa Marie Willson - teresaw@cimcinc.com Carol Jennings - carolj@cimcinc.com Phone: (916) Fax (916) FOR CONFERENCE USE ONLY G PO Amt.: $ PO# Received: G Ck. Amt.: $ Ck.# G C.C. Amt.: $ G Cash: $ Total Number of Registrants: Total Amount Received: $ Date

3 Contact Person: 2012 Public Law National Conference EXHIBIT / VENDOR APPLICATION AND AGREEMENT Tribe/Organization/Company: Daytime Phone: Ext. Fax No.: Address: Website: 1 st Badge Name/Title 2 nd Badge Name/Title TERMS OF AGREEMENT This application/agreement for exhibit space was made and entered into by and between the 477 Conference and Exhibitor. Application for space and its acceptance constitutes a contract to use the space assigned. The 477 Conference retains the right to assign and/or change exhibit locations due to unavoidable problems of the parties involved. The 477 Conference reserves the right to refuse space to applicants whose exhibit materials are deemed to be not within the best interests of the 477 Conference. The Exhibitor indemnifies and agrees to hold harmless the 477 Conference and the Hotel, their officers, directors, employees, and representatives, from and against any actions, losses, costs, damages, claims, and expenses including attorney s fees, arising from any damage to property or bodily injury to Exhibitor, his agents, representatives, employees by reason of the Exhibitor s occupancy or use of the exhibition facilities. In accordance with the forgoing agreement for the 2012 PL Conference, to be held March 5-8, 2012, the undersigned makes application for exhibit space and encloses the full fee for each space requested. Signature: Date: Table Top Exhibit: 1 skirted table / 2 chairs. Limited electricity is available on a first-come, firstserved basis. Meals are NOT included in the exhibit fee; meal tickets may be available onsite. EXHIBIT RATES (Please indicate exhibit type): 477 PROGRAM... $ NATIVE ARTS & CRAFTS... $ plus donation of item for conference drawing NON-PROFIT ORGANIZATION... $ INDIAN TRIBAL ENTERPRISE... $ EDUCATIONAL INSTITUTION... $ GOVERNMENT AGENCY... $ PRIVATE BUSINESS... $ I, hereby, apply for the following number of spaces and agree to pay the appropriate fee. No. of Spaces x $ = $ (fee) Electricity Requested Check enclosed -- make payable to: California Indian Manpower Consortium, Inc. VISA/MasterCard Only Card No.: Cardholder s Name (printed): Cardholder s Signature: Exp. Mail form and payment to: California Indian Manpower Consortium, Inc. 738 North Market Boulevard, Sacramento, CA For further information call: (916) ; teresaw@cimcinc.com or carolj@cimcinc.com FOR CONFERENCE USE ONLY PAID BY: PO AMT.: $ PO NO.: # Rec d: CK. AMT.: $ CK. NO.:# CREDIT CARD AMT.: $ TOTAL AMOUNT REC D: $ CASH $ Date Received:

4 PROGRAM ADVERTISEMENT AGREEMENT Contact Person: Tribe/Organization/Company: Daytime Phone: Ext. Fax No.: Address: Website: Advertisement copy must be in electronic format or as camera-ready art. File resolution should be no less than 300 dpi. Proof (hard-copy) should be mailed with your form and payment for accuracy. Advertisement electronic file or camera-ready art, form and payment must be submitted by January 20, ADVERTISING RATES FULL PAGE (B&W)... $ X 10 HALF PAGE (B&W)... $ X 5 QUARTER PAGE (B&W)... $ X 5 EIGHTH PAGE (B&W)... $ X 2.5 OUTSIDE BACK COVER (7.5 X 10 COLOR)... $1, INSIDE BACK COVER (7.5 X 10 COLOR)... $ Please submit advertisement copy electronically to: teresaw@cimcinc.com or camera ready art by mail to: Teresa Marie Willson California Indian Manpower Consortium, Inc. 738 North Market Boulevard Sacramento, CA by January 20, I, hereby, understand and agree with the requirements of this Agreement and am enclosing the appropriate payment for an advertisement in the 2012 Public Law National Conference program booklet. $ (fee) for a -page Check enclosed -- make payable to: California Indian Manpower Consortium, Inc. VISA/MasterCard Only Card No.: Cardholder s Name (printed): Cardholder s Signature: Exp. Mail form and payment to: California Indian Manpower Consortium, Inc. 738 North Market Boulevard, Sacramento, CA For further information call: (916) ; teresaw@cimcinc.com or carolj@cimcinc.com FOR CONFERENCE USE ONLY PAID BY: PO AMT.: $ PO NO.: # Rec d: CK. AMT.: $ CK. NO.:# CREDIT CARD AMT.: $ TOTAL AMOUNT REC D: $ CASH $ Date Received:

5 SPONSORSHIP OPPORTUNITIES You are invited to be part of the 2012 Public Law National Conference through your sponsorship of this important national event. YES! WE WANT TO BE A PART OF THIS IMPORTANT EVENT BY SPONSORING THE FOLLOWING COMPONENT(S) OF THE 2012 P.L NATIONAL CONFERENCE: (Please check one or more.) One Individual Conference Registration (including travel expenses) - $1,200 Sponsorship includes full-page advertisement in conference program booklet and recognition at Awards Luncheon. One Award Scholarship (including travel expenses) - $1,500 Sponsorship includes full-page advertisement in conference program booklet and recognition at Awards Luncheon. One Mid-Morning or Afternoon Coffee Break - $3,500 Sponsorship includes full-page advertisement in conference program booklet, and prominent signage at break service. Awards Luncheon - $10,000 Partial Luncheon Sponsorship - $ Sponsorship includes full-page advertisement in conference program booklet, prominent signage at event, and table at Awards Luncheon. Banquet - $16,000 Partial Banquet Sponsorship - $ Sponsorship includes full-page advertisement in conference program booklet, prominent signage at event, and table at Banquet. SPONSOR INFORMATION: Contact Name: Tribe / Organization / Company: Daytime Phone: Ext. Fax No.: Address: Website: LOGO & ADVERTISEMENT COPY Logo and/or advertisement copy should be in electronic format. Camera-ready art is also accepted. File resolution should be no less than 300 dpi. Proof (hard-copy) should be mailed with your form and contribution for accuracy. Please submit advertisement copy electronically to: teresaw@cimcinc.com or camera ready art by mail to: Teresa Marie Willson, CIMC 738 North Market Blvd. Sacramento, CA no later than January 20, Donation Amount Enclosed: $ Card No.: Check enclosed -- make payable to: California Indian Manpower Consortium, Inc. VISA/MasterCard Cardholder s Signature: Cardholder s Name (printed): Exp. Mail form and donation to: California Indian Manpower Consortium, Inc. 738 North Market Blvd, Sacramento, CA For further information, call: (916) ; (916) fax

6 PART I - WORKSHOP PRESENTATION This information will be used in the 2012 Public Law National Conference program booklet. Please identify yourself and describe your workshop as you would like it to appear in the Conference program booklet. WORKSHOP PRESENTER(S) INFORMATION Primary Presenter s Name: Grantee/Company/Agency: Address: Daytime Phone: Fax No.: Additional Presenter s Name: Additional Presenter s Title/Company: Ext. Additional Presenter s Name: Additional Presenter s Name: Additional Presenter s Title/Company: Additional Presenter s Title/Company: Please attach a one-paragraph biography for each presenter. WORKSHOP PRESENTATION INFORMATION Length of Workshop Session: 1-1/2 hours 3 hours (2 parts) Are you willing to repeat session? YES NO Preferred Date(s): Tuesday Wednesday Thursday Please provide workshop presentation title and description for conference program (may be edited to meet space restrictions). Workshop Title: Workshop Description: Please submit Workshop/Presenter forms by fax to (916) or to Teresa Marie Willson - teresaw@cimcinc.com cc: carlc@cimcinc.com For information, call (916)

7 Workshop: 2012 Public Law National Conference PART II - WORKSHOP REQUIREMENTS Presenter(s): AUDIO-VISUAL / TRAINING NEEDS CHECK ALL THAT APPLY: PRESENTER WILL BE PROVIDING OWN EQUIPMENT. MICROPHONE NEEDED WIRED WIRELESS HANDHELD HANDHELD PODIUM LAVILIER TABLE FLOOR PREFERRED ROOM SET-UP (please indicate 1st and 2nd choice) PLEASE LIST ALL EQUIPMENT NEEDED TO BE PROVIDED BY CONFERENCE: OTHER: CLASSROOM THEATRE ROUNDS U-SHAPE An effort will be made to provide presenter(s) with preferred room set-up; however it is not guaranteed. HANDOUTS / PRINTED MATERIAL PRESENTER WILL WILL NOT HAVE HANDOUTS. Presenter will be responsible for reproducing own handouts Presenter will send hard copy or electronic copy to be reproduced. Available in electronic format Available in hard copy only If presenter wishes 477 Conference to reproduce handouts - Camera-ready original copy or electronic copy must be received no later than February 20, Handouts to be reproduced by Conference are limited to 20 pages (1 side) or 10 pages (2 sides). ALL OTHER copying, including on-site, will be the presenter s responsibility. A hard copy or an electronic copy of all handouts and PowerPoint presentations must be submitted to the 477 Conference. PART III - PRESENTER AGREEMENT I hereby affirm that none of the material presented in my presentation, to my knowledge, infringes upon the copyright or right of privacy of others, and that material which references work of others will be properly credited to that source. Further, I will not misrepresent, libel or slander, any other person, facility, service or product during the course of my presentation. If such affirmation is breached, I will indemnify and hold harmless the 477 Conference, its officers, directors, employees, and representatives, from and against any actions, losses, costs, damages, claims, and expenses including attorney s fees. Presenter s Signature Date Please submit Workshop/Presenter forms by fax to (916) or to Teresa Marie Willson - teresaw@cimcinc.com cc: carlc@cimcinc.com For information, call (916)