Vendor/ Exhibitor Application for Directors Institute
Arizona Department of Education
Exceptional Student Services
Directors Institute
September 22-24, 2014
http://www.azed.gov/special-education/2014-directors-institute/

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Applications are accepted on a first-come, first-served basis.
Vendor/Exhibitor Registration Fee Includes:
• One 6 ft. covered table  
• Full conference registration for up to two exhibitors
• Breakfast, lunch, and refreshment breaks for up to 2 exhibitors
• Vendor/Exhibitor fee is $400.00 per table
• Applications must be submitted by July, 11
• Payment must be paid in full by August, 25
• Contact Glendale Renaissance Hotel if electricity is required prior to August, 25 at (480) 518-8029

*NOTE: Vendor/Exhibitor tables must be attended by at least one person at all times.
Agency Information
Company/Agency Name *
Company/Agency Address *
Company/Agency City *
Company/Agency State *
Company/Agency Zip *
Last Name (Contact Person) *
First Name (Contact Person) *
E-Mail Address *
Phone Number *
Cell Phone Number *
Fax Number *
Exhibitor Information
Company Name *
Company Name as you would like it printed in the brochure
Table Requirements/Accommodations
Exhibitor(s) ADA Accommodations *
Specific ADA Accommodations Request
If you answered "yes" above, please indicate the type of accommodations needed:
Registration Fees
• Payments must be paid in full by August, 25
• No cancellations
• No refunds
Exhibitor Tables: "For-Profit" Agency/Organization
Clear selection
Exhibitor Tables" "Non-Profit" Agency/Organization
If necessary, call Rocio Munoz at 602-542-0610 or via email at Rocio.Munoz@azed.gov, for sliding scale fee information.
Clear selection
Non-Profit Agency/Organization Only
Would you be willing to share a table with another non-profit should space be limited?
Clear selection
Conference Participation Information
Maximum of two individuals per day.
Last Name of Exhibitor #1 *
Monday, September 22
First name of Exhibitor #1 *
Monday, September 22
Lunch Request *
No Preference
Vegetarian
Vegan
Other
Monday, September 22
If you selected "Other":
Please describe/explain your food needs.
Last Name of Exhibitor #2
Monday, September 22
First Name of Exhibitor #2
Monday, September 22
Lunch Request
No Preference
Vegetarian
Vegan
Other
Monday, September 22
Clear selection
If you selected "Other":
Please describe/explain your food needs.
Exhibitors for Tuesday
Last Name of Exhibitor #1
Tuesday, September 23
First name of Exhibitor #1
Tuesday, September 23
Lunch Request
No Preference
Vegetarian
Vegan
Other
Tuesday, September 23
Clear selection
If you selected "Other":
Please describe/explain your food needs.
Last Name of Exhibitor #2
Tuesday, September 23
First name of Exhibitor #2
Tuesday, September 23
Lunch Request
No Preference
Vegetarian
Vegan
Other
Tuesday, September 23
Clear selection
If you selected "Other":
Please describe/explain your food needs.
Next Steps
Important!  Please print this form for your records. Upon completion of your registration you will receive a confirmation page. If you do not, your registration is not complete. If you have questions or require additional information, contact Rocio Munoz via email at Rocio.Munoz@azed.gov or by telephone:  (602) 542-0610.  

You will be contacted regarding acceptance as a vendor at the Arizona Department of Education Directors Institute within 2-3 business days of application submission.  If you do not receive a confirmation, please contact Rocio Munoz via email at Rocio.Munoz@azed.gov or by telephone:  (602) 542-0610. Please remember that vendor/exhibitor tables must be attended by at least one person at all times.
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